Let GPs prescribe heroin, says former top drugs adviser

Nick Cohen reports on a bitter dispute over treatment of addicts

BRITAIN should reverse its drugs policy and go back to allowing GPs to prescribe heroin and cocaine to addicts on the NHS, the man who was the Government's senior drugs adviser said shortly before his death three weeks ago.

In a valedictory condemnation of the Home Office and Department of Health, Bing Spear, the former Chief Inspector of the Government's Drugs Inspectorate, said that a 1968 policy change, which ended the unique "British system" of allowing doctors to keep patients away from dealers by giving them hard drugs, had been an "unmitigated disaster".

In the 25 years since, control of drug treatment has been in the hands of about 100 clinical psychiatrists, nearly all of whom prefer to get patients off heroin by using the synthetic substitute methadone. Most addicts regard methadone as a bland alternative to the real thing.

In his final paper - which will be published by the Institute for the Study of Drug Dependence (ISDD) in September - Mr Spear echoes the beliefs of many senior police officers that addicts on methadone are topping up with heroin bought from dealers with the proceeds of crime.

"The changes in prescribing policy were damaging because of the very obvious effect they had on drug use beyond the clinics' doors - never something to concern the clinical psychiatrists," he writes. Their "consistent refusal to acknowledge many of the realities of the wider addict world has been mainly responsible for the increasing irrelevance of the 1968 responses".

Psychiatrists, Mr Spear adds, are too influenced by American demands to prohibit drugs, and do not pay enough attention to the economic and social reasons behind addiction.

Mr Spear's attack comes after the failure to contain addiction was made strikingly evident in a study from Manchester University, which predicted last week that the majority of 14 to 16-year-olds would experiment with drugs by 2000. While the figures rise, the last remnant of the "British system" of dealing with hard drugs is collapsing. It had survived the Eighties in a small treatment centre in Widnes, Cheshire, where staff led by John Marks - a flamboyant NHS consultant psychiatrist rarely out of the national press - gave crack cocaine and heroin to patients, saying it stopped them robbing and mugging to fund their habit and allowed those who could not give up to lead relatively normal lives.

The Chapel Street Clinic attracted worldwide attention and was warmly praised by patients, police and business leaders for cutting drugs-related crime in Merseyside. However, the local health authorities removed the contract to treat addicts earlier this year and gave it to doctors who believe in prescribing methadone.

Dr Marks' practice has dwindled from 400 to just 40 patients, referred to him by GPs from the rest of Britain. Last week Dr Marks broke from the traditions of academic reticence and attacked the Royal College of Psychiatrists, whose arguments were used by the NHS to justify removing his contract.

In the ISDD journal Drug Link, he criticised "London psychiatrists ... who have consistently advised the Government that drug takers cannot be maintained indefinitely on heroin, cocaine or other drugs" for imbuing a "generation of doctors with false premises".

The dispute has become very bitter. From Dr Marks's side come claims that born-again Christians in powerful positions took against him, and accusations that the Americans wanted the Department of Health to close his clinic after it was given national publicity in the United States. US anger increased when it was revealed that an unnamed American television star was given heroin and cocaine by the clinic when he visited Britain.

His opponents have cast strong doubt on his anti-methadone policies. Andrew Johns, a psychiatrist at the St George's Medical School in south London, said in the British Medical Journal that giving cocaine and heroin to patients had had disastrous results in the Sixties. Dr Marks ignored the "ethical imperative that medical treatments should lead to some health gain by patients".

Paula Grey, public health officer for North Cheshire Health Authority, said that his Widnes clinic's contract to treat local patients had been taken away because it was too expensive to buy heroin. There were also "inevitable fears" that the drugs could "leak out" of the clinic.

Former Widnes patients of Dr Marks said they had been devastated by the decision. Maureen Laverty said she had been prescribed heroin for five years. "I got a job as a nursery nurse, settled down with a partner and had a baby," she said.

"Now we are being told that we must move to methadone. I just can't do it. I'm in a desperate situation. There are people I know who are going back to prostitution and crime because of what has happened."

The last authoritative academic survey found that although more addicts on methadone were trying to give up drugs completely than patients receiving prescribed heroin, the methadone users were three times more likely to "top up" with drugs bought illegally.

Home Office civil servants, meanwhile, concede in private that they are becoming increasingly alarmed at the number of people who are dying from misusing methadone.