Reducing deaths among drug misusers

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7289.749 (Published 31 March 2001) Cite this as: BMJ 2001;322:749

Tighter legal controls on drug prescribing are not the answer

  1. Mark B Gabbay, senior lecturer in general practice,
  2. Tom Carnwath, consultant psychiatrist,
  3. Chris Ford, general practitioner,
  4. Deborah A Zador, lecturer, University of Sydney, and head
  1. University of Liverpool, Liverpool L69 3GB
  2. Substance Misuse Services, Trafford, Manchester M33 1FD
  3. Kilburn, London NW6 6RR
  4. Drug and Alcohol Department, Concord Repatriation General Hospital, Concord, NSW 2139, Australia

    Rising drug related deaths alarm treatment providers, legislators, and society. The recent report from the Advisory Council on the Misuse of Drugs, Reducing Drug Related Deaths, suggests that lax prescribing is responsible for a significant proportion.1 It supports recent national guidelines on managing drug misuse, emphasising the supervised consumption of controlled drugs.2 On the same theme, the UK Home Office proposes extending the licensing system for addiction prescribing to cover all controlled drugs except NHS prescriptions for methadone mixture.3 Yet an expansion in the licensing system is likely to reduce accessibility of treatment and so increase drug related deaths. We believe that a clinical governance based solution would more successfully enhance treatment quality, safety, and accessibility.

    Currently Home Office licences cover only heroin, cocaine, and dipipanone, and about 100 doctors (mainly specialist psychiatrists) have licences. The licences encompass prescriptions for about 500 patients, most of whom receive heroin. Monitoring is indirect and low key, aimed at detecting negligently aberrant prescribing and self …

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