Drug Addiction treatment in Britain can be determined by this issue of where seven doctors charged of careless prescribing are to appear before the General Medical Council. The hearing is the biggest in the 145-year history of the disciplinary body - never before have so many doctors been charged jointly with serious professional misconduct. And it will represent a showdown between rival schools of medical thought - at loggerheads over how drugs should be prescribed to recovering addicts. The seven accused worked at a private Drug treatment centre in Essex, the Stapleford Centre, where about 200 Heroin addicts are receiving prescriptions for controlled drugs.
Some of the Stapleford patients received "maintenance prescriptions", some for many years that enabled them to keep jobs and have stable lives while paying the pounds 100-pounds 200 weekly costs of prescriptions. But the charges against the doctors are that the amount of drugs prescribed was excessive, creating the potential for them to be sold on, and that some patients were not properly monitored. One patient died. The GMC's headquarters in London has been cleared for the hearing, which is due to last three months. Other cases have been moved to other locations so extra rooms can be allocated to the lawyers, witnesses and the vast quantity of documents needed for the case.
The previous largest case to be heard by the GMC involved three doctors accused over the deaths of babies in the Bristol heart surgery scandal in 1998. That case, which lasted nine months, changed the face of medicine in Britain and led to the introduction of regular checks on doctors' performance to ensure they did not put patients at unnecessary risk. The defendants in the current case include Colin Brewer, 62, founder and medical director of the centre, who is known internationally for his work in Drug abuse. He is now retired. Three of his co-accused has left the Stapleford Centre, and three are still practicing there. The case is likely to highlight a philosophical conflict in the treatment of Drug abuse which dates back more than 20 years. NHS treatment centers have historically taken a tough approach to addicts, insisting they wean themselves off drugs and accept oral Withdrawal is less severe. It is used as a substitute for heroin in the treatment of addicts.">Methadone as a substitute for injectable heroin.
Although that policy has been relaxed over the past decade, with a new emphasis on "harm reduction" and acceptance of maintenance prescribing, NHS centers are still seen as operating tough, restrictive rules. The Stapleford Centre has adopted a more liberal prescribing policy, giving patients maintenance prescriptions of the drugs they want in order to take them out of the black market and enable them to live stable lives. They have been readier to respond to patients' requests, particularly if they showed they could hold down a job. A source at an NHS treatment centre said: "It is a philosophical clash. They [the Stapleford] handed out high doses of drugs, of different sorts, both oral and injectables. They were operating almost like a grocery. They did it because they believed it to be right but we don't do it in the NHS because we believe it to be wrong."
The source added: "But setting that aside, we argue that whatever philosophy you follow, you must deliver safe care." Supporters of the Stapleford Centre say that, in the past, single- handed private doctors who treated addicts did little more than take money for drugs. The difference with the Stapleford was that it took the treatment of abuse seriously, offering Detoxification and treatments such as the Heroin blocker naltrexone to help addicts come off drugs. "The whole thing about Stapleford is that it wasn't one of those dodgy single-handed practices," one said.
Bill Nelles, executive director of the Withdrawal is less severe. It is used as a substitute for heroin in the treatment of addicts.">Methadone Alliance, a support group for Drug abusers, said: "The issue is how liberal we are going to be or how much control and supervision we are going to insist on over the patient. Are we going to make them accountable for every ampoule of drugs?" The National Treatment Agency for Substance Misuse, part of the Department of Health, said it supported maintenance programmes as a mainstay of Drug treatment. It is highly expected that the seven doctors accused will deny the charges of wrong prescribing.
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