news analysis of GPs` opposition to prescribing heroin to addicts

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

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

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

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

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.

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