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GPs can throw addicts a lifeline through substitute prescribing



I spend part of my week in the substance misuse service. It’s a very different set up to general practice: I have half an hour with every patient and I see them at least once a month, sometimes more.

I know everything about them, from family woes to pending court cases. I know about their rising rent arrears, their dirty urine samples and their clapped-out cars, and I help them make agonising decisions. I’ve seen at first hand what the dragging weight of poverty does to a person; it slowly drowns them.

I think we’re being too soft on them,’ said the medical student who was sitting in with me. She sat sour-faced and truculent in the corner and clearly thought that what I was doing was a waste of time. ‘They’re still on methadone so it means it hasn’t worked,’ she said.

For her, long-term substitute prescribing was the clear chemical marker of failure and no arguments about harm reduction would wash. She explained that patients’ benefits should be slashed if they injected and that someone, perhaps a social worker, should shout at them if they misbehaved. But then she became even more interesting. She intimated that the real reason there’s such a big drug problem in Scotland is because unlike in the Far East we don’t have the death penalty for drugs offences.

‘The death penalty in the Philippines is a deterrent,’ she said confidently, ‘which is why there are hardly any addicts there.’

I didn’t have the strength to argue. It seems that a supposedly enlightened medical student, just a year away from qualifying, would rather see a human life extinguished at the end of a taut rope than accept the shortcomings of our western medical liberalism.

I asked her if she really wanted to live in a society like the Philippines or any other society which carries the death penalty for drugs offences. I asked her if she’d be prepared to work as a prison doctor and inject the lethal cocktail into guilty veins. I asked her what she’d feel like walking into the execution chamber to pronounce life extinct, and I asked her to imagine looking at the freshly dug earth next to the prison each morning on her way to work.

I didn’t get any straight answers from her and she just asked me to sign her off as having attended a speciality clinic.

If someone is trying to swim across the green river of methadone to get to the other side, shouldn’t we lighten their load rather than weighing them down? Shouldn’t we throw them a rope rather than looking on as they’re swept away and drowned in the current?

Dr Kevin Hinkley is a GP in Aberdeen.