GMC TO DECIDE IF CONTROVERSIAL CLINIC IS AIDING OR HARMING DRUG ABUSERS

For more than two decades, doctors have been divided over how to tackle the
modern scourge of drug addiction. Some have claimed the only ethical
approach is to wean patients off injectable heroin, with its addictive
"rush", on to the slower-acting oral methadone, then reduce the dose.

Others insist addicts cannot be forced to give up drugs until they are
ready. They say that, until then, it is far better to give them the drugs
they need, and keep them in touch with medical services, than abandon them
to the black market.

The General Medical Council is now to arbitrate in this dispute in the
biggest case it has heard in its history involving seven doctors from a
private treatment centre. The Stapleford clinic in London has been treating
drug addicts for 17 years. It was founded in 1987 by Colin Brewer who
already had experience treating alcoholics with the drug antabuse.

He was asked by the Home Office to take over the treatment of addicts who
had formerly been treated by a private Harley Street practitioner, Ann
Dally. She had been found guilty by the GMC of excessive prescribing and
forced to give up her practice. At about the same time, another GP, John
Marks, who pioneered the prescribing of heroin to drug abusers in
Liverpool, was forced to abandon his practice because of Home Office
pressure. He said he had helped patients lead stable lives and cut crime
rates in the area. He is now living in New Zealand.

Ironically, Dr Brewer, who thought he had the support of the Home Office,
now finds himself on the wrong side of it in the same way as Dr Dally and
Dr Marks did.

But at the start, all went well. He offered addicts rapid de-toxification -
withdrawal from drugs - followed by treatment with naltrexone, a heroin
blocker. The naltrexone meant that even if the patient relapsed and
injected heroin it would have no effect; the naltrexone stopped the heroin
causing the usual rush. The idea was that this would help the addict to
walk past a dealer without feeling impelled to score.

At the same time, Dr Brewer took on patients for maintenance, those not yet
ready to go the detox and naltrexone route but who were looking for a
steady source of drugs to stabilise their lives. He believed it was
necessary to offer different categories of drug, which might vary at
different times, to suit patients' needs. The Stapleford clinic gained a
reputation for offering the widest rage of treatments in the country,
including opiates, amphetamines, tranquillisers, anti-depressants and
anti-psychotics, as well as detoxification with naltrexone.

As more patients sought out Dr Brewer, he took on extra doctors to handle
the demand. With private fees averaging between UKP100 and UKP200 a week,
the clinic was turning over a substantial sum. And during the 1990s, the
tide seemed to be moving in Dr Brewer's favour.

The resistance to maintenance prescribing of the NHS treatment centres
softened as recognition grew that their tough approach was not working.
Injectable drugs became acceptable again - albeit for a minority of abusers
- - and centres were criticised for handing out methadone in inadequate doses
which were less than addicts needed.

Last May, the Home Office declared an expansion of heroin-prescribing on
the NHS and published new guidelines for doctors licensed to provide it. It
was the clearest signal of the new liberal approach to the treatment of
drug addiction. But for Dr Brewer's critics in the NHS, the prescribing
policy adopted by the Stapleford clinic was too liberal. The clinic was
accused of functioning "almost like a grocery" for drug addicts.

Supporters admit it was liberal about the drugs it handed out. But they
claim it was better to be too liberal than not liberal enough. They say
some drugs could have been diverted to the black market, but the amounts
involved would have been insignificant.

Backers of the clinic say that it saved lives. Its critics say it did more
harm than good. The GMC will decide where the balance lies.