GMC strikes off expert in drug addiction

BMJ 2006; 333 doi: (Published 16 November 2006) Cite this as: BMJ 2006;333:1035

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  1. Owen Dyer
  1. 1London

    An expert in drug addiction who is viewed by some as a pioneer in his field has been struck off by the UK General Medical Council after a case lasting almost three years (BMJ 2004;328:483).

    Colin Brewer, the former medical director of the private Stapleford Centre Addiction Treatment Clinic, was the only one of seven doctors from the clinic to lose his right to practise.

    Two other doctors from the clinic were also found guilty of serious professional misconduct. Ronald Tovey had conditions imposed on his registration, and Hugh Kindness received a reprimand. Charges against four other doctors from the clinic were found not proved in 2005.

    The Stapleford case has been the longest and most complicated in the history of the GMC. The panel sat for 82 days and examined more than 1500 prescriptions.

    Dr Brewer was found to have provided treatment that fell short of medical standards in the cases of 13 patients. In the most serious case, 29 year old Grant Smith died while using a home detoxification kit that contained 16 different drugs. His mother, who was supervising the treatment, said that she had been unaware of the need to watch her son even while he slept. The GMC panel found the instructions for the kit confusing and unclear.

    Other shortcomings noted by the panel included Dr Brewer's failure to do an adequate initial assessment or dose assessment; failure to maintain adequate contact with patients or to monitor compliance; and failure to notify patients' general practitioners or refer patients for other medical conditions. Dr Brewer was also found to have prescribed opiates for pain without considering the underlying condition.

    Prescriptions at the clinic were often large, allowing a potential for diversion. One patient's prescriptions were collected on 34 occasions by six different people, some of whom were known addicts.

    Dr Brewer also ignored warnings in the British National Formulary about the use of several drugs that are now considered dangerous or addictive, such as dexamfetamine, barbiturates, dextromoramide, and flunitrazepam (Rohypnol).

    Dr Brewer took over the Stapleford Centre, which has branches in Essex and Belgravia, London, at the request of the Home Office in 1987 after the clinic's previous director was found guilty of overprescribing. He earned a reputation as an innovator, pioneering the use of naltrexone in opiate withdrawal and developing for the Home Office a successful programme to treat drug addiction in prisons.

    Denis McDevitt, chairing the GMC's fitness to practise panel, told Dr Brewer, “You brought to the treatment of drug addicts a clinical concern and interest that does not always appear to be a feature of their treatment by others. You have practised outside established guidelines because you have considered, rightly, in some instances, that this was in the best interests of your patients.”

    But Dr Brewer had grown overconfident and dismissive of other views, he said, and had placed too much trust in patients. Defence counsel William Edis, noting that Dr Brewer has been retired since 2003, asked that a condition be placed on his registration barring him from treating patients. But the panel ruled that only his erasure from the medical register could restore public confidence in the medical profession.