• Reducing deaths among drug misusers ~ (March 31 2001 editorial published in British Medical Journal)
  • General Medical Council may be destroying the British System ~ Arnold's Response
    • The current state of dependency management in the UK ~ Dr. Byrne responds to Arnold
      • Your letter raises many important issues ~ Arnold responds to Dr. Byrne
  • Standard of care in Britain was not addressed ~ Andrew Byrne's Response
• Authors' Reply

EDITOR Gabbay et al argued that tightening controls by extending the licensing system to all controlled drugs is likely to bring about adverse consequences.1 Drug related deaths will increase in number rather than decrease. The hidden message in the editorial, written by four doctors experienced in treating addiction, was equally important. There is a growing and ultimately destructive schism in the United Kingdom's medical profession regarding the proper controls on doctors treating drug misusers.

On the one hand, there are doctors such as Gabbay et al who argue that the British approach to treating drug misusers has enduring value. This means that the judgment of an individual doctor should be trusted in tailoring treatment for each patient. Thus, each drug misuser is treated as a patient with unique needs, and drug misusers in general as constituting a heterogeneous, not a homogeneous, population. Trust in doctors extends to decisions to prescribe narcotics. Doctors operating from the British system assume that there is no specific treatment of drug abuse. This realistic concept has encouraged experimentation and innovation by British doctors, including general practitioners, in taking on and treating difficult patients. Medical practice based on the British system has worked to hold down the spread of addiction and disease.

On the other hand, there are doctors wielding considerable power in the drug misuse establishment who view the clinical freedom accorded by the British system as both an anachronism and a threat to public health. This politically dominant group of doctors has, over the past several decades, imposed increasing control on the clinical freedom of doctors abiding by the British system. This control has been implemented through several editions of clinical guidelines and also through an activist role for the General Medical Council: the GMC disciplines and erases selected doctors who abide by the approach of the British system to helping drug misusers. These actions by the GMC have been viewed as arbitrary and unpredictable by respected medical experts. Many doctors are afraid to accept drug misusers as patients because they worry about being irrationally persecuted by the GMC.

The planned extension of the licensing system to all controlled drugs would be an illness masquerading as a cure. Stricter controls signal the death knell for a humanitarian and efficacious system of addiction prevention and treatment. The GMC has a duty to keep that tragedy from happening. Yet it almost seems intent on creating it.

Arnold S Trebach, professor emeritus. American University, Box 185, 5505 Connecticut Avenue, NW, Washington, DC 20015-2601, USA arnold@trebach.com

Competing interests: AST is an adviser to John Patrick Hickey of Cornwall; an expert witness to the court in various legal matters involving Dr Hickey.

1. Gabbay MB, Carnwath T, Ford C, Zador DA. Reducing deaths among drug users. BMJ 2001; 322: 749-750[Full Text]. (31 March.)