Misusers may receive methadone from drug centres and GPs simultaneously

Editor—Heroin use continues to rise in England and Wales,¹ and the government has recently outlined steps to combat this increase.² The misuse of drugs (supply to addicts) regulations of 1997 revoked the requirement for all doctors to send to the Home Office details of drug addicts. Previously, the regulations of 1973 required that “any doctor who attends a person who the doctor considers or has reasonable grounds to suspect, is addicted to any of the 14 notifiable drugs shall, within seven days of the attendance, furnish in writing particulars of that person to the chief medical officer.”³ The index of addicts has now been closed, although doctors are expected to continue to report drug misusers and their treatment to the appropriate regional or national drug misuse database.

During June to July 1998 we became aware of several cases of simultaneous prescription of methadone and other misused drugs by both our centre and local general practitioners. This is worrying for three reasons. Firstly, it may increase the risk of methadone overdose, the subject of a recent study in Manchester.⁴ Secondly, the opportunity for diversion of prescribed drugs to the illicit market is increased, thus undermining the harm minimisation strategy of prescribing drugs of misuse. Finally, it undermines effective management plans in both primary and secondary care and contributes to the prescribing problems highlighted in other studies.⁵

When the notification system was in place it was in principle a simple matter for any doctor to obtain information about a potential drug misuser’s treatment. However, with the abolition of compulsory notification, information held in local drug misuse databases can no longer be said to be reliable and is usually inaccessible due to anonymous recording techniques. We are aware that staff at the local West Midlands database have noticed that some subjects have been entered by two different sources and may be receiving two or more prescriptions simultaneously. Currently, these staff have no way of alerting medical staff to their findings.

Ultimately, the risk of dual prescribing could lead to increasing vulnerability for general practitioners, who may be liable to criticism in the case of overdoses or accidental deaths from prescribed drugs. The ensuing reluctance to consider prescribing for drug misusers can lead only to pressure on specialist drug services and so inhibit the government’s desire to broaden the scope of medical management of drug problems.