Intended for healthcare professionals


Reducing deaths among drug misusers

BMJ 2001; 323 doi: (Published 01 September 2001) Cite this as: BMJ 2001;323:512

General Medical Council may be destroying the British system

  1. Arnold S Trebach, professor emeritus (
  1. American University, Box 185, 5505 Connecticut Avenue, NW, Washington, DC 20015-2601, USA
  2. Drug and Alcohol, 75 Redfern Street, Redfern, New South Wales 2016, Australia
  3. London NW6 6RR
  4. Manchester M33 1FD
  5. University of Liverpool, Liverpool L69 3GB

    EDITOR—Gabbay et al argued that tightening controls by extending the licensing system to all controlled drugs is likely to bring about adverse consequences.1 Drug related deaths will increase in number rather than decrease. The hidden message in the editorial, written by four doctors experienced in treating addiction, was equally important. There is a growing and ultimately destructive schism in the United Kingdom's medical profession regarding the proper controls on doctors treating drug misusers.

    On the one hand, there are doctors such as Gabbay et al who argue that the British approach to treating drug misusers has enduring value. This means that the judgment of an individual doctor should be trusted in tailoring treatment for each patient. Thus, each drug misuser is treated as a patient with unique needs, and drug misusers in general as constituting a heterogeneous, not a homogeneous, population. Trust in doctors extends to decisions to prescribe narcotics. Doctors operating from the British system assume that there is no specific treatment of drug abuse. This realistic concept has encouraged experimentation and innovation by British doctors, including general practitioners, in taking on and treating difficult patients. Medical practice based on the British system has worked to hold down the spread of addiction and disease.

    On the other hand, there are doctors wielding considerable power in the drug misuse establishment who view the clinical freedom accorded by the British system as both an anachronism and a threat to public health. This politically dominant group of doctors has, over the past several decades, imposed increasing control on the clinical freedom of doctors abiding by the British system. This control has been …

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