Re: COUNSEL’S OPINION ON THE LEGALITY OF PRESCRIBING METHADONE TO ALCOHOL DRINKERS

To: Paddy Tipping MP

From: Robert Beckett

House of Commons, London SW1A 0AA

By email:  30 November 2008

  Dear Paddy, 

Recent copy correspondence and counsels’ opinion has clearly shown that HM Government is wasting hundreds of millions of taxpayers' pounds on treatments for the addicted which do not work, have no real outcomes and are killing people by the thousand on a yearly basis. UN/WHO guidelines for treatment are completely ignored.

 You are familiar with my own struggle with alcoholism which ended only when I was introduced through the independent healthcare sector to abstinence-based treatment for my addictive disorder/disease. I am pleased to tell you that I will soon celebrate 22 years of sobriety.

 There seems to be a plethora of controlled drinking and drug programmes around, hearkening back to the halcyon days of the 60's and 70's when we believed that the brave new world of pharmaceuticals would cure everything including addiction to alcohol and drugs. Alas, it was not so.

It is only now that we can see the true cost of not treating addictive disorders properly and in line with reality. We see children turning up at the Queen’s Hospital intoxicated when they should be tucked up in bed with a teddy. We see our city centres full of what appears to be hordes of people drinking out of control. It seems that every old bank or building society has become a pub selling alcohol at increasingly low prices.

 I am truly saddened by the lack of progress in the UK in coming to terms with dependency. It is the national shame that no one dares to mention. But mention it we must.

 First, however ,I give credit where credit is due. I would like to acknowledge the groundbreaking efforts of the Nottingham PCT for its enlightened approach to this problem, announced on the front page of the Evening Post last Saturday night. This brings a little light to a country which has a massive problem. This must be followed up by a national initiative along similar lines.

WHO SPENDS MONEY ON CONTROLLED SMOKING?

 Whoever heard of money being spent on "controlled smoking" programmes for those suffering from the side effects of smoking tobacco?

The NHS runs a very effective programme called Can we help you stop smoking. There is no reference to the notion that we can control it. The secret of its success lies in the simple truth that we all know we cannot control such things. Cessation for people with side effects is the only route forward. Smoking is more often than not an addiction to nicotine. 

 Those who can "take alcohol or leave it" are not included in the group referred to in this correspondence. Nothing wrong with a drink as the sun sets over a day full of frustrations… It is only when we experience problems with drinking that we need to seek assistance and consider the options open to us. We would not be seeking help if we could control alcohol or drugs. 

How crazy can things get when we have controlled drugging programmes and methadone substitution for an activity which is labelled criminal in the first place? Hundreds of millions of pounds are being wasted in the middle of a recession on freakery from the past: harm reduction started in the ‘80s to prevent the spread of infection diseases such as Aids; it is also a good engagement tool – but it was never designed to replace treatment proper.

UN / WHO CRITERIA & THE LAW

 The UN and WHO have clear definitions for alcohol and drug dependency which they consider to be primary illnesses. The clinical criteria set out for the disease clearly calls for the presumption of abstinence. This, of course, is not always a possibility at the first attempt. It doesn't mean, however, that we should not encourage cessation for those diagnosed "dependent". Whatever happened to the try, try and try again philosophy?

 Politicians and public alike are alarmed at the 810,000 alcohol-related admissions to NHS hospitals at an annual cost to the taxpayer of £2.5 BILLION. UNLESS AND UNTIL WE UNDERSTAND THE TRUE NATURE OF THE DISEASE OF ALCOHOL AND DRUG DEPENDENCY NO REAL INROADS TO THIS CATASTROPHE CAN OR WILL BE MADE (apologies for the capitals).

 I appreciate that treatment services around Nottinghamshire are being reviewed and re – provided so as to be in line with legal requirements. However, it seems that those at the helm in Whitehall are oblivious to the unlawful activity they are directing across the whole of the UK in terms of commissioning risky treatment.

 The National Treatment Agency study entitled Does the combined use of heroin or methadone and other substances increase the risk of overdose? states the following:

 "As in heroin cases, the threshold for fatal methadone overdose would also appear to be lowered by alcohol, especially in females. Female methadone maintenance clients who use alcohol may therefore be at elevated risk of fatal overdose.  Treatment agencies and policymakers should consider alcohol use to be a principal risk factor".

 It is a public scandal that methadone (discovered in Nazi Germany) has continued to be used by HM Government and its agencies as a replacement for clinically-driven treatment, presumably to lower the crime statistics. Also, methadone is an addictive drug, harder to withdraw from than heroin – so how can patients move on to drug-free lives?

 The International Classification of Diseases 10^th Edition sets out the criteria for alcohol and drug dependency. The definition of the disease includes symptoms of:

• A strong desire or sense of compulsion to take the substance;

• Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use

•  Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill non tolerant users);

The definition does not make a distinction made between one drug and another – eg, between heroin and alcohol – in terms of describing the clinical elements of dependency.

xxx

In the light of this study, I believe that prescribing methadone for a person who is by definition addicted to alcohol is tantamount to wanton neglect in the event of a fatal overdose occurring in line with the attached report. 

xxx

Under these circumstances, any reasonable doctor or clinician should be aware that the patient (by their own determination in prescribing methadone) could not stop or control their drinking and that death was a foreseeable and probable consequence of this treatment combined with alcohol.

xxx

 I do not believe that HM Government would consciously allow a practise to be used which research indicates kills people daily, seemingly to reduce the crime statistics around the use of heroin.  These people came to us for help to stop their addiction only to find themselves locked up in the misery of methadone addiction.

 I intend to brief our administrative solicitors to seek leading counsels' opinion on this matter. In the meantime, I would be most obliged if you would be kind enough to hand a copy of this letter to members of the All Party Commons Select Committee on Alcohol who are currently reviewing evidence of this nature. I would also be obliged if you could obtain the views of the Secretary of State for Health on the precise issues raised in this communication.

 I look forward to hearing from you.

 Kind regards

Bob Beckett

Director – CITIZENS VOICE