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Drugs campaigners say prescribing more heroin to addicts will lead to reduced crime and better health outcomes. Family doctors are less convinced. Katie Leason reports.

Family doctors made it clear last week they were against any increase in the prescribing of heroin to addicts, and GP involvement in such prescribing.

The Royal College of General Practitioners presented evidence to the home affairs select committee after home secretary David Blunkett announced last October that he would be introducing new guidance on prescribing heroin. The home office anticipates a rise in the number of addicts receiving prescribed heroin from 400 to as many as 1,500.

RCGP drugs spokesperson Dr Claire Gerada told the committee there would be "no added value" from general practitioners prescribing heroin. Gerada accepts that prescribed heroin can be an option for a small proportion of patients who have failed other forms of treatment, but claims there are a number of safer alternatives that are easier to administer, more evidence-based, and work better. She warns that prescribing heroin can lead to a "lifetime of addiction", and denies that it is fair to call it treatment. "I think it’s a form of social control," she adds.

But opinion within the profession is divided. Middlesbrough GP Dr Ian Guy, who specialises in drug addiction, believes heroin should be prescribed more often and that more doctors should be licensed to do it. "Increased prescribing by GPs is a first step," he says, explaining that he would like addicts to be able to buy the drug from a licensed outlet.

John Beer, chairperson of the Association of Directors of Social Services health and social inclusion committee, points out that GP-prescribing is not the only option. He says the best approach to heroin misuse is the development of a range of policies, which could include an increase in the prescribing of heroin if it was proven to be another way to help addicts come in for treatment. "It doesn’t have to be an alternative to other things," he insists. "If it is clinically better for some people then we should explore its uses. For drug addicts, the most important thing is to get them into treatment."

Cost is another huge factor. In her evidence to the committee, Gerada put the cost of a year’s heroin treatment at between £10,000 and £15,000 per patient - compared with around £2,000 for methadone.

But the drug campaign group, Transform, argues that prescribing heroin makes economic sense when you look at the wider picture. They believe it would be cheaper to meet the additional prescription costs than to fund the criminal justice system to deal with those who offend to feed their habit.

Transform backs the prescribing of heroin in principle, but emphasises that the decision should be a clinical one made between doctor and patient. Transform director and former drugs worker Danny Kushlick describes doctors’ unwillingness to prescribe more heroin as "hypocritic not Hippocratic" given their comparative willingness to prescribe for around a million tranquilliser addicts.

Meanwhile, drugs charity DrugScope proposes the targeted expansion of prescribing heroin as "a bridge into treatment", insisting that research shows positive benefits of prescribing heroin to a certain type of addict in terms of health and crimes committed.

Whether GPs are suitably trained to deal with addiction is another matter altogether. Birmingham GP and NHS Alliance special adviser on drug misuse Dr Andrew Thompson says that the training GPs receive on addiction amounts to about half an hour at medical school and whatever they experience during postgraduate training. This, he says, results in GPs saying they are unable to deal with the problem and referring addicts to community drug action teams, which tend to have long waiting lists.

The home office promises new guidance in December this year. A spokesperson said the home office was hoping to increase the number of specialist clinics prescribing heroin. What GPs’ roles will be within that remains to be seen.