How a lack of direction in treating drug-users leaves doctors in a state of limbo
The UK has a substantial range of services for medicating drug users, however the current system of treatment is extremely complex with different doctors, clinics and health authorities prescribing differing treatments according to their own individual philosophies. These take place in a myriad of different locations, from NHS clinics, private health centres, specialist drug centres, doctor’s surgeries and residential treatment centres. The nature of problematic drug-use varies depending on the substance involved, the individual’s level and length of use, their living conditions and so on. These complexities go some way in explaining why treating drug-users varying dependencies are so diverse. Unlike other conditions doctors and medical professionals deal with, there are no standardised and uniform procedures.
The recent case of doctor being investigated because of the death of a number of his patients has prompted a series of reviews into drug-user treatment. This case from the United States of the doctor being disciplined for his prescribing activities which resulted in the death of 11 patients since 2003 from overdosing on a range of drugs from heroin to oxyContin, Methadone and morphine raises how complex and serious an issue heroin assisted treatment is. This follows a similar case in the UK in 2004 where seven drug treatment specialists where accused of prescribing over-excessive quantities of heroin and methadone in one of the biggest disciplinary cases the UK’s General Medical Council has seen. The Stapleford centre, one of the UK’s biggest and most respected private drug counselling and treatment clinics where the doctors were based, assessed that the recipients of the drugs were not yet ready to come off their drugs and thus the continuation of their heroin and methadone treatment were maintained.
These cases of doctors being disciplined stem from the maintenance school of thought developed in the 1960’s when heroin was much more openly provided as a treatment for users (read about a users experience in the 1960's here). The first of these doctors whom now has an almost mythical status among the UK’s underground drug culture was Dr John Petro, who because of his clinical preference for prescribing heroin to users was struck off from practicing medicine. However, with decades of conservative government stretching from the late 1970’s to the early 1990’s it was the abstinence approaches that triumphed, with drug-users healthcare and support becoming secondary concerns.
However, with the realisation that that system was utterly failing, there was a general increase in support for heroin assisted treatment for users with controlled supervision and support also helping to undercut the illegal drugs market. Nevertheless, a concrete policy of how best to deal with the issue has never been solidified made worse by a lack of research through which to support the maintenance approach. There have been studies of heroin assisted treatment in Switzerland, Germany and the Netherlands and Canada showing benefits in user’s health and their psycho-social adjustment into a more sustainable way of living. However, a lack of meaningful research carried out in the UK seems to undermine any calls for an increase in such treatment and as has been shown, doctors prescribe such treatments at their own peril and at the mercy of the health regulatory institutions. Furthermore, the likelihood that the conclusion of these studies which seem to be overwhelmingly supportive of heroin assisted treatment being transcended into policy is deemed as political suicide and as such, isn’t touched upon by politicians.
These irregularities in treatment can in part be explained by the lack of an adequate top-down direction in how to treat users. By looking at the issue of heroin assisted treatment, only two or three adequate studies have been carried out into its effectiveness. When one considers the scale of the public health issue around problematic opiate use in its various forms, this lack of adequate research goes some way in explaining why there is such a lack of direction in how best to deal with these users.
Therefore the lack of a suitable framework whereby doctors are comfortable in their prescribing of certain treatments to drug-users and when there are cases such as the ones mentioned, it is all too easy for the individual doctors to be scapegoated, taking the problem away from the governing medical authorities. The government and the relevant health institutions lack of a concrete position in this situation is clearly a contributing factor in the uncertainty facing doctors dealing with drug users. These users are not only a problem no one wants, but a problem no one wants to talk about. No one is really sure of how many people are addicted to heroin and opiates and no one really knows the social and economic cost. The history of drug-user treatment has been characterised by disputes and disagreements over the best approach. Treating drug-users doesn’t just involve medicine and psychiatry but a range issue like social housing, the criminal justice system, employment and so on. Until there is a serious degree of leadership and willpower by the policy makers in really dealing with this issue, it seems doctors will remain in limbo about how best to treat drug-users.