Drug treatment is proposed to manage child sex offendersBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39257.583310.BE (Published 28 June 2007) Cite this as: BMJ 2007;334:1343
New proposals on the management of those who commit sexual offences against children in England and Wales will include the use of drug treatments, said the home secretary, John Reid. The drugs, to reduce libido, would be given on a voluntary basis.
The drugs envisaged are of two types: antidepressants of the selective serotonin reuptake inhibitor (SSRI) class and hormonal treatments designed to reduce testosterone concentrations.
Dr Reid also announced plans to allow limited disclosure of sex offender status to parents or guardians. Parents and guardians who are concerned that someone in contact with their child may be a convicted sex offender can register their interest in that person with the police. Police and child protection workers will then consider whether confirming that a person is a sex offender is warranted, with a “presumption that this information will be disclosed” if the offender is deemed to be a risk. This falls short of the US-style “Megan's law” demanded in a media campaign led by the newspaper the News of the World, which would allow all members of the public to access the names, addresses, and photographs of all convicted child sex offenders.
Parents who received disclosed information will be legally bound not to share it with others, warned Terry Grange, the police's spokesman on child protection and chief constable of the Dyfed-Powys Police Force. The scheme will be piloted in three police forces, which are yet to be named.
Napo, the probation officers' union, welcomed the decision to stop short of publicly naming offenders, but its assistant general secretary, Harry Fletcher, said that the plan “still sounds like a sop to certain tabloid papers.”
“It is extremely worrying that the home secretary has spoken of the need to break the monopoly of information about sex offenders held by professionals,” he said. “The information is not a commodity; it is highly sensitive and must be kept confidential.”
Other features of the proposals include satellite tracking of the highest risk offenders and compulsory polygraph tests to verify that those on probation are not reoffending.
The plan to explore drug treatment was described by several newspapers as “chemical castration,” a label rejected by Dr Reid, who argued that it can be a useful adjunct to psychological treatment.
Don Grubin of Newcastle University, a psychiatrist who treats small numbers of convicted sex offenders with both antidepressants and anti-androgenic drugs, said that although hormonal treatment can achieve reductions in libido similar to those achieved by orchidectomy, the effect is reversible, and the drug may be titrated to achieve only partial suppression of sex drive.
The drugs are already used in the United States and several European countries, he said. Evidence of their effectiveness is “not very strong, nor of the highest quality, but on balance it's probably safe to say they can help in some cases.”
But he cautioned: “An unusually powerful sex drive is a major factor in only a minority of sex offences.” Professor Grubin estimated that less than 5% of sex offenders would benefit from hormonal treatment and less than 10% from antidepressants. “But that is still more than are receiving these treatments today,” he said.
“So long as it is done voluntarily and for the treatment of the individual, not as a means of social control, I think it's a sensible enough proposal,” he added.
Seven US states have laws that make hormonal treatment compulsory for certain categories of child sex offenders. Three of these states—Texas, Florida, and California—have laws that permit child sex offenders to request surgical castration as an alternative.
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