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| GPs Voice Reservations About an Expanded Role |
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Posted by CN Staff on May 21, 2002 at 20:47:03 PT By Kirsty Scott Source: Guardian Unlimited 
For Dr Mark Palmer, prescribing heroin is always a last resort. The 41-year-old Cheshire GP is part of a team treating 350 patients at the Trafford Substance Misuse Service in Manchester, but only a handful are given a prescription for diamorphine and only when all else has failed. "It is not a cure-all," said Dr Palmer. "But you will come across people who, over a period of months or years, have been unable to improve their overall health. They are damaging themselves. There may be some serious ulceration of the leg or they will have lost some toes. They have been prescribed methadone but they don't stabilise on it. Out of 350 patients probably about 10 to 15 of them are on a prescription for diamorphine. There are one or two people who you will put on this and their overall health improves dramatically." Despite the benefits for some addicts, Dr Palmer is concerned at any effort to expand the role of GPs in the prescription of heroin. He works closely with other drug specialists and the heroin treatment is initiated by a consultant. While they don't actually supervise the injecting, Dr Palmer and his associates monitor the patient closely, making sure they are going to the right chemist. The GP service, he said, is not designed to take on that role. "The problem is if you have just GPs on their own they get targeted by users and you get difficult situations arising. In our drug team two of us work in conjunction with a drug worker. Drug patients are very manipulative. It is much harder in a one-on-one situation, in a GP's surgery to hold the line." Dr Roger Smith, a primary care drug addiction specialist with the Sheffield drug action team, agrees. Dr Smith, 58, is currently renewing his licence to prescribe heroin, although he has not used it since moving clinics last year. "We were prescribing it for a very select group of patients, maybe 2%, who had tried everything else. Eventually we would offer them this to stabilise the situation. In the people we did this for it worked extremely well. They were able to go on with their life." Dr Smith would like to see heroin remain available as a treatment but says its medical use must be scrupulously controlled. "It would not work for everybody," he said. "I think the whole thing needs to be revisited. It ought to be an option in treatment and I think it needs to be really carefully controlled because what happened before in the British system, it got out of hand and was leaking on to the streets. We need to have supervised injections, which we did not have. That needs to be the safeguard." It is six years since Dr Chris Ford first applied for a licence to prescribe heroin. She has been turned down twice and told she needed to have a psychiatrist attached to her practice and extra qualifications. The London GP and chair of the Methadone Alliance sees around 100 drug users in her Kilburn surgery and believes diamorphine can be a vital tool in the treatment of some addicts. "For a long time I have felt there should be more options," she said. "If you look at diabetes there are 40 drugs to choose from but for drug treatment the tool box is fairly limited in terms of what you can prescribe." Dr Ford, 50, said she will probably reapply for a licence but worries that the latest initiative might backfire. "Drug treatment is still a postcode lottery," she said. "My concern is that this is being pushed before we have basic good drug treatment services for everybody. I would like to be able to prescribe heroin but I am anxious that if we add something on to something that is not very good what happens then? If you give licences to GPs and we do it badly and don't solve the war on drugs - which it won't - they might say, 'heroin didn't work.' But heroin is so good for the right people I would not like to see any policy that could make it not be available." Note: Prescription: Control seen as key to success with addicts. Special Report: Drugs in Britain -- http://www.guardian.co.uk/drugs/0,2759,178206,00.html Newshawk: puff_tuff Related Article & Web Site: Drugs Uncovered: Observer Special A Fresh Approach To Clubbers' Drug Home Comment Email Register Recent Comments Help |
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