PRESCRIBE HEROIN TO ADDICTS

North Ormesby is bleak. Houses are boarded up, cars burnt out and used
needles scattered in the road and on the pavements. But next door to the
baby clinic in this Middlesbrough suburb, a GP has opened a pioneering
practice that he believes will revolutionise the treatment of Britain's
300,000 heroin and cocaine addicts.

With David Blunkett, the Home Secretary, staking the future success of his
drugs policy on an extra UKP183m to be spent on the treatment of addicts,
blamed for Britain's current crime wave, Dr Ian Guy's new scheme will be
eagerly assessed.

Dr Guy is thought to be the only GP in the country whose patient list
consists only of drug addicts and their families. His is a life spent
dispensing methadone, Subutex, lofexidine and naltrexone to 450 registered
patients. Almost all of them are addicted to heroin; some of them are
addicted to crack cocaine as well. It represents a fraction of Teesside's
estimated 5,000 to 20,000 addicts.

Dr Guy used to be a "regular" GP but after studying heroin addiction he
decided to specialise - still as a GP. He began his specialist programme in
April 2001 but hopes to see similar schemes around the UK. He works out of
several health centres in the city but will open his own premises followed,
he hopes, by a licence to inject addicts with NHS-supplied heroin.

"Most when they come to us are fairly desperate because they have been on
our waiting list for quite some months," said Dr Guy. "Treatment has got to
start when there is a window of opportunity; when they feel ready for
whatever reason."

In the waiting room sit patients with gaunt, drawn faces. The majority are
aged between 18 and 30 but some are older and, tragically, some are younger.

Dr Guy would like to be able to offer the most hardcore addicts, those who
have not taken to other treatments, free heroin injections. The Government
wants to increase by five times the number of addicts allowed heroin on
prescription. Many GPs are resistant to the idea of having to inject heroin
addicts in their surgeries, of having addicts sitting in waiting rooms with
"regular" patients. Not Dr Guy. "It is a project I would love to have. We
would assess the patient, calculate a starting dose and the patient would
administer the heroin to themselves with a nurse present. We would see the
effect and put the dose up so that they are comfortable then prescribe it
daily but have them come in and inject it until we are confident they are
stable. The point is to undercut the black market."

Dr Guy accepts the war against drugs cannot be won. "We have to accept that
drugs are here to stay and we have to work out the best ways of reducing
the harm," he said."If prohibition worked that would be fine, but if we
can't keep it out of our prisons, how can we keep it out of the country?"

John Simpson, 38, a bricklayer, had an appointment with Dr Guy to change
his medication. He wanted to switch to a more stabilising heroin substitute
to enable him to work more frequently. "I was daft to get on to it in the
first place but it is just too easy," said Mr Simpson. "I started off on
prescription painkillers and when someone offered me some heroin I stupidly
took it.

"I was in tears when I came in the first time, saying I had to get off the
stuff. I have been on the programme for a while and it is a great
treatment. As long as people want it to work it does seem to. The best
thing is not to get on it in the first place."