TREATMENT
THE HEAT IS
ON
Patrick Guenette/Alamy
In the second part of ‘Doctor Wars’, Bill Nelles
describes the tumultuous days of the 1980s
By 1983, the cold
war among doctors
treating drug users was
becoming a lot hotter,
and there was still no
public health response to drug use.
The Home Office consultants still
met regularly, and included private
doctors as well as NHS consultants.
The NHS doctors felt the private
doctors prescribed overly generously,
didn’t demand reductions, left their
patients ‘still addicted’, and even
charged them fees. The private
doctors felt the NHS doctors were
too rigid and their patients poorly
treated. Guidelines on the treatment
of drug misuse (‘orange guidelines’)
were the first national guidance
issued by this group in 1984 – they
pleased few. For instance, the
guidelines considered that medically
supervised detoxification was a
‘simple and short-term process with
spontaneous remission possible’,
and also stated that maintenance
was not acceptable. ‘Evidence-based
treatments’ didn’t really exist in
addiction medicine at that time.
Ironically, the main use of the
orange guidelines was as evidence
in 1986 at Dr Anne Dally’s General
Medical Council (GMC) hearing. She
was a feisty senior private doctor on
the working group and one of the
signatories of the 1984 guidelines.
I gave testimony supporting her at
her GMC hearing, having become
the drug education officer at the
Terrence Higgins Trust (THT) a year
earlier, but her verdict was guilty of
maintenance! While she was able
to still be a doctor, she was never
allowed to prescribe controlled
drugs again. Her practice evaporated
almost overnight.
Because of its policy of avoiding
methadone and arresting users for
the possession of syringes alone,
Scotland was one of the first parts
of the UK to see the unusual and
mostly lethal illnesses associated
with AIDS and injecting drug
use. Cheap heroin from Iran and
the easy availability of Temgesic,
(ironically, an early sublingual
form of buprenorphine) had vastly
increased the number of people
injecting opioids, and police
pressure had made clean needles
impossible to obtain.
But two factors had yet to
By 1983, the cold
war among doctors
treating drug users
was becoming a lot
hotter, and there
was still no public
health response to
drug use.
reveal themselves. The first was,
of course, the AIDS epidemic, with
the first Scottish drug user dying in
Scotland in 1983. The second was
the growing involvement of general
practitioners in providing services
to drug users and their influence
on practice. Britain had not made
methadone a drug needing a Home
Office licence, and thanks largely
to the efforts of dear Dr Tom Waller
– an ACMD member who batted it
back every time it was put forward –
it was never adopted as policy.
These trends intersected in
early 1985, when a young GP in
Edinburgh published a paper in
the BMJ which galvanised me, and
many others, into serious action. Dr
Roy Robertson, (now the Queen’s
physician in Scotland and professor
of addiction at Edinburgh University),
had been seeing drug users for
some years, and maintaining some
with dihydrocodeine. He was able
to obtain HIV test kits in advance of
their national availability, and in late
’84 had taken blood for HIV antibody
assay from around 160 patients. He
knew they shared used needles, and
the paper showed that 51 per cent
had already been infected by HIV.
The effect of this news cannot
be exaggerated. Research testing
in London was showing rates of
under 5 per cent positive, so we
realised we had a short window
to make a difference if we moved
fast. By the summer of 1986, teams
in London, Liverpool, Edinburgh
and Amsterdam and, of course,
the US were working very hard to
understand what they were facing,
and the UK and Holland had already
14 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020
WWW.DRINKANDDRUGSNEWS.COM