LIBERAL HEROIN TREATMENT IN THE DOCK AT GMC'S BIGGEST HEARING

Seven doctors accused of irresponsible prescribing are to appear before the
General Medical Council today in a test case that could determine how drug
addiction is treated in Britain.

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 UKP100-UKP200 weekly cost 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 have left the
Stapleford Centre, and three are still practising 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 centres
have historically taken a tough approach to addicts, insisting they wean
themselves off drugs and accept oral 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
centres 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 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.

The seven doctors accused are expected to deny charges of inappropriate
prescribing.