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Misconceptions over opiate users

From Dr James Mather

Malvern, Worcestershire

Phil Peverley's contributions are very amusing and I look forward to them every week. He makes us laugh. Heaven knows with the cuts in primary care budgets now apparent, we all need that. Peverley writes about the butt-end of primary care and makes us all feel there are others feeling the pain. That's good.

However, his article on helping opiate users (Columnists, 22 June) is full of misconceptions. He is correct in saying that opiate addiction is not an illness and does not have a medical solution. Nonetheless, the condition does lend itself to harm-reduction interventions.

Among these are structured substitute medication prescribing which has been shown to reduce acquisitive crime, reduce harmful injecting practices, and reintegrate patients into work, family and a substance-free life.

In my years prescribing in a structured scheme (for more than seven years) in primary care, we have seen many positive outcomes. This is good cost-effective medicine – acquisitive crime has dropped by over 50 per cent since we started our service.

Finally, the Friday afternoon scenario doesn't happen because the users know we don't prescribe without swabbing to provide proof of use. Prescribing substitute medication would prevent the scenario that formed the whole basis of Phil Peverley's article, so really Phil should be sabre-rattling for shared care for substance users.

• From Dr Colin Lees


I have never agreed so much with an article as I do with Phil Peverley's column on drug addicts. He has made some very unpopular and politically incorrect statements, but really I would suspect that the great majority of people, medical and otherwise, would be in total agreement with him.

Should the addicts wish to come off drugs, they should be helped, but over a very short timescale. The idea of giving out methadone as a replacement for heroin is outrageous as this just changes them from one addictive substance to another.

All that seems to be happening is producing an ever-increasing number of methadone addicts, rather than getting heroin addicts completely and quickly off all drugs. It would be nice to be able to go into a pharmacist's shop and not be pushed out of the way by a demanding addict, in for his or her daily methadone fix.

• From Dr Muriel Simmonte

Locality drug consultant and primary care facilitator, Lothian

I read Phil Peverley's thoughts on drug addicts with interest. I have worked with drug users for over 16 years, both as a GP and more recently as a locality drug consultant.

If the scenario he describes is actually true – and I have never met anybody who presented because they had 'left their stash' – then his decision not to prescribe was spot on. Nobody would advocate prescribing acutely for a temporary resident with no motivation to change who had not been fully assessed or already stabilised on treatment.

Peverley advocates that, in terms of treating drug users, we should 'just stop'. Well again I agree that he certainly should, if he ever actually started. The cliche of Herod providing child care comes to mind.

He describes the problems of heroin withdrawal as being no worse than the common cold, but managing opiate dependency is more complex than a single episode of heroin withdrawal.

Untreated heroin dependence is associated with a mortality rate around 12 times that of a user's peers – a higher mortality rate than even the most severe coryza.

And far from treatment, including prescribing, being 'like throwing petrol on a fire', there is extensive evidence that good-quality treatment reduces mortality and morbidity, improves social functioning and reduces criminal activity.

But then why let the facts get in the way of a good rant?

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