Prescription for better care
The cover story for the next issue of Druglink (May/June) out this week, concerns heroin prescribing with an exclusive inside look at the workings of the current UK heroin trial. But we also feature an article that looks back to a time when the only treatment for drug problems was a visit to the local GP.
Up until 1968, any GP could prescribe drugs to a user in support of their addiction. No other country allowed this and so it became known as the 'British System'. Of course, the user population was very smaller than today, just about into four figures - and located primarily in London and the south East. And there were some villains among the hero doctors, who were just in it for the money. But the principle was sound - you could see a local doctor who would assess your problem and prescribe if necessary. In fact, the head of the Home Office Drugs Branch at the time, Bing Spear, later called the decision to ban doctors from prescribing as one of the biggest mistakes of British drug policy. He strongly believed that doctors could be trusted in this respect and that the use of the Home Office Tribunal System (never properly implemented) could have dealt with any rogues.
Instead, community doctors were taken out of the treatment mix and it has taken decades to make any inroads into bringing GPs round to the idea that they can treat people with drug problems. Much of the credit for this goes to the SMMGP (Substance Misuse Management in General Practice), who recently held their 12th Annual Conference. The first conference was very sparsely attended: now 600 delegates are turning up with many more turned away. But much work remains: still only around 25% of GPs have any caseload of drug users and the rudimentary nature of GP training in this area doesn't help.
But it could well be the future: the idea that drug treatment becomes more of a mainstream responsibility for health and social care. If drug users are to be brought in from the margins, then GPs should be brought along as well.
http://www.smmgp.org.uk
