Intended for healthcare professionals

Rapid response to:

Head To Head

Should heroin be prescribed to heroin misusers? No

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39422.503241.AD (Published 10 January 2008) Cite this as: BMJ 2008;336:71

Rapid Response:

Prescribing heroin for drug addicts -the fantasy must end.

The Editor,
British Medical Journal

Dear Sir

Prescribing heroin for drug addicts -the fantasy must end.

I note the debate regarding prescribing heroin 1 I have to admit I
have done rather well out of this controversy with three separate
editorials to my name2 3 4 5. Personally, I feel the evidence shows that
the “medical” benefits of heroin prescribing are negligible although it is
likely to reduce acquisitive crime in the small number who receive
prescriptions. However the “medical evidence” is entirely irrelevant. The
UK Randomised Injecting Opioid Treatment Trial study of diamorphine
prescribing costs around £15 000 per addict per year for medication6. (I
read about this in The Sun7, Britain’s most popular newspaper, in an
article entitled “Junkies get NHS heroin”. This also contains the
statement, “The cost of the heroin treatments is up to £15,000 per
patient. It comes as the National Institute for Clinical Excellence denies
Alzheimer’s sufferers drugs costing £2.50 per day.”) Giving heroin for
addicts to inject at the taxpayer’s expense is political suicide. Any
British (or American) career politician would dive for cover. This is self
evident even to an amateur politician such as myself. (I am a “wobbly
Conservative” Councillor for the local Borough Council). Of course, the
Prime Minister is not an amateur. He is a vastly experienced, competent,
premier league Parliamentarian. If he were to endorse an expansion of NHS
heroin prescribing the Opposition would have a field day. (“Does the Prime
Minister really support a policy which requires doctors to act as
legalised drug dealers?”) The press would crucify Gordon Brown and, lets
face it, the British Press hate him anyway. It‘s a lesser point but,
following the MTAS fiasco and the reduction in burden of proof in GMC
cases, Gordon Brown is about as popular as cancer with the medical
profession. Consequently doctors leaders are likely to join the mob baying
for his blood. (At least they would if they were not so spineless.) Anyone
who imagines that the British Governments would endorse an expansion of
heroin (“diamorphine”) prescribing to addicts is living in a political
fairyland.

Yours sincerely,

Councillor Dr Jason Luty MB ChB Bsc PhD MIBiol CBiol MRCPsych
Southend Borough Council (Conservative)
Consultant in Addictions Psychiatry. South Essex Partnership NHS Trust
Honorary Consultant in Addictions Psychiatry, Cambridge & Peterborough
Mental Health Partnership NHS Trust

1. Rehm J, Fischer B & McKeganey N (2008) Should heroin be
prescribed to heroin misusers? BMJ 2008;336:70-71

2. Luty J (2005) New guidelines for prescribing injectable heroin in
opiate addiction
Psychiatric Bulletin, Apr 2005; 29: 123 - 125.

3. Luty J (2004) New guidelines for prescribing injectable heroin to
addicts. Journal of Substance Use 9, 2-4.

4. Luty J (2003) Prescribing injectable heroin to addicts: unproven,
unpopular, unbelievable. Journal of Substance Use 8, 5-6.

5. Luty J (2003) Hospital Doctor. May Pp 16

6. Randomised Injecting Opioid Treatment Trial (RIOTT)
http://www.iop.kcl.ac.uk/projects/?id=10114 (Accessed 12/01/2007)

7. The Sun (2007). Junkies get NHS heroin. 20 November
http://www.thesun.co.uk/sol/homepage/news/article484023.ece (Accessed
12/01/2007)

Competing interests:
None declared

Competing interests: No competing interests

13 January 2008
Jason Luty
Consultant in Addictions Psychiatry. South Essex Partnership NHS Trust
Southend on Sea, Essex SS4 1RB
The Taylor Centre, Essex Street