This piece was primarily stimulated by conference presentation by Dr Colin Drummond that you can find on Lifeline’s FEAD website.
If Colin thought that psychiatrists were demonized by commissioners and the NTA, he really needs to look and see what the recovery lobby have got to say about them. Anyway, somebody raised the question of why psychiatry should be responsible for drug treatment in the first place.
To answer that question, you have to look back at the demise of the old British System. Prior to the 1960’s, heroin addicts in the UK were invariably drawn from one of two groups. They were either ‘therapeutic addicts’, people who had gotten dependent on opioids as a result of having been prescribed them for pain relief. Or they were medics — people who had access through their jobs. These people were largely indistinguishable from the rest of the community and so the old British System — prescribing them sufficient heroin to meet their needs — worked well.
This began to change at the start of the 1960’s when the media and the Home Office both began to notice an upswing in a ‘new’ type of heroin user. Unlike the previous groups, these tended to be young, criminally deviant with attitudes that challenged the system. Rather than keeping to themselves and just using their scripts, these people seemed to be socializing with and ‘infecting’ other young people. Consequently, the prevalence of heroin use (and addiction) was growing exponentially.
So in 1961, the government convened a committee of the Great and the Good to look at the issue and decide whether anything needed to change. But doctors guarded their independence with great vigour, and argued that the current system was working well.
Rather than settling down though, the problem just kept on growing. The papers were starting to report some of the excesses associated with the old British system. You had the likes of Dr Petro, setting up his clinic in the cafe at Piccadilly Underground, selling heroin scripts at £3 a time to get the cash to go gambling. Or Dr. Frankau, who seemed to keep a staff of servants drawn from her patients.
When the Brain Committee was reconvened in 1964, they decided that the dramatic growth in overprescribing was really a function of this small handful of overprescribing doctors. It’s certainly true that that’s where the drugs were coming from in London. The demand for amphetamines on the mod scene was fuelling pharmacy break-ins in other parts of the UK, but there certainly wasn’t any significant quantity of imported illicit heroin until we started seeing small quantities of imported Chinese heroin on Gerard Street in the early 70’s.
The Brain Committee then, decided to put an end to the old free-for-all, in which any GP could prescribe any drug they liked, in any quantity, to any heroin addict that was their patient. It recommended the establishment of a number of specialist treatment centres — which came to be called Drug Dependency Units or DDU’s — that would be responsible for the treatment of heroin addiction. If a doctor wanted to prescribe to addicts, they had to have a Home Office special licence that would allow them to prescribe heroin and cocaine. (In the mid-70’s, Diconal was also added to this list — a measure that saved a lot of limbs, as well as a lot of lives.)
And who was to staff these Drug Dependency Units? Well, addiction was viewed primarily as a psychological problem, so didn’t it make sense to staff the units with psychiatrists? And thus begun the long term relationship between psychiatry and treatment for drug dependency that lasted for for nearly 50 years in the UK, but that Colin Drummond feels today is under attack.
And Professor Drummond isn’t wrong. When I entered drug treatment in 1975, I’d see a Consultant Psychiatrist twice a week. Some were awful, but the majority of them were humane, intelligent people who did their best for their patients.
Although the guidelines say a patient should be seen at least quarterly, in many services it’s not unusual to be seen every six months — perhaps even every year. And you might be seen by an unskilled, unqualified ‘Recovery Coach’ who’s volunteering after being six months drug free.
We used to pretend drug treatment was a ‘Cinderella service’, but for most of the last fifteen years, it’s actually been a ‘Sleeping Beauty’ service, and as the princess lay sleeping on her bed, the world was passing her by.
Today, we’re in a new world, and as Professor Drummond astutely points out, it’s unlikely that the pendulum will ever swing back to where it used to be.