It is not true that I "took over the Stapleford Centre...in 1987
after the clinic's previous director was found guilty of overprescribing."
After about 15 years as a general psychiatrist with an interest in alcohol
abusers[1,2] I started offering only oral naltrexone treatment (and the
rapid and well-cushioned detox/induction process that it usually needs)in
1986, soon after naltrexone became available in Britain[3]. I named the
service after the nearest village to the Essex clinic where most patients
were treated.
Ironically, like many doctors, I was not initially very keen on
methadone maintenance treatment (MMT), partly because I thought that
opiates should be decriminalised so that doctors would not need to be
involved. However, I soon realised that abstinence-based treatment did not
suit all opiate abusers and also that MMT was even then strongly supported
by controlled studies. I thought about establishing a tightly-controlled
US-style oral MMT unit but before it became more than a thought, I was
suddenly deluged with the former patients of Dr Ann Dally after her
prescribing was restricted by the GMC in 1987. They had been given my name
by the Home Office, who presumably realised that I was one of the few
addiction specialists then interested in pharmacological approaches.
Given what had just happened to Dr Dally, I was understandably
reluctant to take over their prescribing but you are right to say that I
eventually did so "at the request of the Home Office". For many years, I
believed that we had a good relationship with their Drugs Branch, a belief
reinforced when around 2001, another part of the Home Office - the Prisons
Department - invited us, as you report, to set up a model treatment
programme for the drug-related (or more often, Prohibition-related)
offenders who form the majority of prison inmates. Incredibly, we were not
informed when later in 2001, the Home Office abandoned its supervisory
role for prescribing doctors without putting anything else in its place
other than the rather blunt and very expensive instrument of referral to
the GMC.
I do not claim that we always managed perfectly the difficult
balancing act that such treatment involves but as the GMC almost
explicitly recognised, NHS detox and maintenance services are, even now,
often difficult to access and often not very good when patients eventually
succeed in getting an appointment. There is a lot more to be said about
this hearing and about addiction treatment in Britain but this is not the
time to say it.
REFERENCES.
1. Brewer C, Meyers RJ & Johnsen J. Does disulfiram help to prevent
relapse in alcohol abuse? (Invited review) CNS Drugs 2000;14329-341
2. Brewer C, Smith J. Probation-linked supervised disulfiram in the
treatment of habitual drunken offenders: results of a pilot study.
British Medical Journal 1983;287:1282-83.
3. Brewer C, Rezae H, Bailey C. Opioid withdrawal and naltrexone
induction 48-72 hours using a modification of the naltrexone-clonidine
technique. Br J Psychiatry 1988;153:340-343.
Rapid Response:
True origins of the Stapleford Centre
It is not true that I "took over the Stapleford Centre...in 1987 after the clinic's previous director was found guilty of overprescribing." After about 15 years as a general psychiatrist with an interest in alcohol abusers[1,2] I started offering only oral naltrexone treatment (and the rapid and well-cushioned detox/induction process that it usually needs)in 1986, soon after naltrexone became available in Britain[3]. I named the service after the nearest village to the Essex clinic where most patients were treated.
Ironically, like many doctors, I was not initially very keen on methadone maintenance treatment (MMT), partly because I thought that opiates should be decriminalised so that doctors would not need to be involved. However, I soon realised that abstinence-based treatment did not suit all opiate abusers and also that MMT was even then strongly supported by controlled studies. I thought about establishing a tightly-controlled US-style oral MMT unit but before it became more than a thought, I was suddenly deluged with the former patients of Dr Ann Dally after her prescribing was restricted by the GMC in 1987. They had been given my name by the Home Office, who presumably realised that I was one of the few addiction specialists then interested in pharmacological approaches.
Given what had just happened to Dr Dally, I was understandably reluctant to take over their prescribing but you are right to say that I eventually did so "at the request of the Home Office". For many years, I believed that we had a good relationship with their Drugs Branch, a belief reinforced when around 2001, another part of the Home Office - the Prisons Department - invited us, as you report, to set up a model treatment programme for the drug-related (or more often, Prohibition-related) offenders who form the majority of prison inmates. Incredibly, we were not informed when later in 2001, the Home Office abandoned its supervisory role for prescribing doctors without putting anything else in its place other than the rather blunt and very expensive instrument of referral to the GMC.
I do not claim that we always managed perfectly the difficult balancing act that such treatment involves but as the GMC almost explicitly recognised, NHS detox and maintenance services are, even now, often difficult to access and often not very good when patients eventually succeed in getting an appointment. There is a lot more to be said about this hearing and about addiction treatment in Britain but this is not the time to say it.
REFERENCES. 1. Brewer C, Meyers RJ & Johnsen J. Does disulfiram help to prevent relapse in alcohol abuse? (Invited review) CNS Drugs 2000;14329-341
2. Brewer C, Smith J. Probation-linked supervised disulfiram in the treatment of habitual drunken offenders: results of a pilot study. British Medical Journal 1983;287:1282-83.
3. Brewer C, Rezae H, Bailey C. Opioid withdrawal and naltrexone induction 48-72 hours using a modification of the naltrexone-clonidine technique. Br J Psychiatry 1988;153:340-343.
Competing interests: None declared
Competing interests: No competing interests