Self regulation is necessary in war on drugs

Editor—In their editorial on why Britain’s drug czar must not wage war on drugs Strang et al strongly advocate a pragmatic approach by the government to the national and international drug problem.¹ In doing so they seem keen to protect the relative medical autonomy in treatment of addicts afforded by the “British system.”² They call for a maintained emphasis on evidence based treatment, rehabilitation, and preventive strategies and quote the success of the needle and syringe exchanges, as well as the tolerance of injectable heroin and methadone prescribing, as examples of this pragmatic approach.

As well as advantages, however, there are surely disadvantages afforded by a system largely devoid of regulation. The most frequently expressed concern is that of widespread diversion of prescribed drugs to the black market.³ As a profession, we seem to be doing little to rebuff such criticism. The recently published results from a survey of community pharmacies showed prescribing of injectable methadone to be as prevalent in the non-specialist as in the specialist field.⁴ Indeed, relatively simple controls, such as prescription facilities for daily collection of drugs, were shown to be underused in general, and in particular in the private sector. Doses prescribed were also larger in the private sector than the NHS sector.

As prescribers, we must recall the authors’ message to reduce harm to individuals and society.¹ If we are to protect our British system from legislation that is considered the norm in other countries, we must, firstly, make proper use of the simple controls available to us. Secondly, we must develop an array of biochemical tools, both qualitative and quantitative, which will allow us to monitor both use of non-prescribed drugs (“use on top”) by individuals and diversion of prescribed drugs to the black market. The need for such measures has been recognised for several decades,⁵ but little progress has been made. For those receiving prescriptions for long term methadone maintenance and for the minority who receive prescriptions for oral amphetamines or injectable opiates, we must ask questions such as “How much?” and “When?” as well as distinguishing the illicit from the pharmaceutical preparations.

To protect society from the diversion of prescribed substances, as well as to help the individual addict to battle the loss of control that is central to his or her death, we must have self regulation before exposing ourselves to the whims and prejudices of the new drugs czar.