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NEWS: Owen Dyer Seven doctors accused of over-prescribing heroin BMJ 2004; 328: 483 [Full text]

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Several Inaccuracies

Jim L Barnard   (27 February 2004)

In reply to Several Inaccuracies

Ian Harris   (28 February 2004)

Diamorphine prescribing is in charges.

Owen Dyer   (1 March 2004)

Re: In reply to Several Inaccuracies

Jim l Barnard   (1 March 2004)

Several Inaccuracies 27 February 2004
Jim L Barnard, primary care adviser SMMGP, ashton lane sale M33 6WT Send response to journal: Re: Several Inaccuracies	There are several inaccuracies in the piece by Owen Dyer. Firstly the Stapleford Clinic has never prescribed heroin as no Dr there has a home office license to prescribe diamorphine. Secondly the case is not about methadone maintenance as the charges relate to inadequate supervision, inadequate record keeping, inadequate contact with GPs and others, irresposibly large doses and dangerous detoxification procedures, with one death being cited. Thirdly, methadone maintenance is the accepted treatment nodality in the NHS and is advocated in the national clinical guidelines. There are a few areas that still do not offer it but they are coming under heavy pressure from the National Treatment Agency. The recommended doses are possibly lower than in the Stapleford clinic but they are in line with international evidence. Competing interests: None declared
In reply to Several Inaccuracies 28 February 2004
Ian Harris, Chairman RM10 Send response to journal: Re: In reply to Several Inaccuracies	Jim, The fact is that the allegations are that dia-morphine had allegedly been prescribed by some of the stapleford doctors without having a licence to do so and the dates of prescribing and patients initials was stated as well.. I agree with you, that it is not about maintenance of methadone MMT. I think it is mainly the combinations of drugs to a few certain patients, however, this was over a decade or more. To put things in context, since a car accident my wife has been given 6 types of different drugs, anti-inflammatory and pain killers ranging from Paracetomol through to Subutex and on till Dyhidrocodein and a certain anti-inflammatory, after being given many types to try.. So in a short space of time my wife had somewhere up to 12 different types of drugs before anything was found to work for her. The Subutex, gave her a raging headache. The others just did not work. The allegation that G.P's were not informed is one such charge which surprised me, however, as far as supervision is concerned, the stapleford has ever since I have visited it, been methodical with regards Test Dose's at the start, 1 maybe 2 are taken plus hair test approximately every 2 months or so. One thing is for sure, the Stapleford has 'saved many lives' has 'stablished many lives', I fail to see that this is not a clear fact of the situation. Irresponsibly large doses ; I really cannot see how anyone can say 'large-dose', surely it is 'relative', large dose to one person is a small dose to another. The only way large-dose can be said, is if you compare it with something. Therefore, if you are saying large-dose's compared to that given by Statue/Voluntary community based drug agencies then yes they are 'large-doses' or on the other hand, the community based drug agencies are giving 'small-doses. We must except innocence until guilt is proven. Ian. Ian Harris (Mr.) REFORM Tel: 0208 595 4375 Competing interests: None declared
Diamorphine prescribing is in charges. 1 March 2004
Owen Dyer, BMJ news reporter BMJ Send response to journal: Re: Diamorphine prescribing is in charges.	Dr Barnard, Diamorphine prescribing is mentioned in several of the charges. For example, the first head of accusation against Dr Brewer says: "Between 31 May 1990 and April 2003 you and other doctors prescribing at the Centre issued to Mr RF prescriptions for Methadone mixture, Methadone tablets and Methadone ampoules, Morphine Sulphate Continus, Dexedrine, Diamorphine, Paperevetum, Oromorph, tincture of Opium, Dihydrocodeine, Diazepam, Temazepam, Rohypnol, Nitrazepam, Sevredol, Omnopon, and Palfium variously, on numerous occasions. Details of such prescribing are set out in schedule A attached." Also, I was unaware that I had said the case was about methadone maintenance. My introduction reads: "Seven drug addiction specialists were accused by the General Medical Council this week of excessive prescribing of heroin and other drugs, and inadequate surveillance of patients." I would never wish to prejudge any GMC case. If it seems to any readers that I personally credit or reject any of the accusations, please put it down to bad writing. Competing interests: I wrote this news article.
Re: In reply to Several Inaccuracies 1 March 2004
Jim l Barnard, primary care adviser SMMGP, ashton lane sale M33 6WT Send response to journal: Re: Re: In reply to Several Inaccuracies	Ian I take your points, however I was not offering my opinion, just stating what I have taken to be the facts around this case. I think private medicine has a particular problem with supervision, however, as in order to implement the clinical guidelines (3 months supervision) the cost of the treatment would be uneconomic for the patient. Competing interests: None declared