Cut methadone use or you won't turn tide of drug addiction, ministers are warned

The SNP has pledged a sea change in treatment services, away from "managing" drug misuse to helping addicts become clean, to reduce the burden borne by society as a whole.

But Professor Neil McKeganey, one of the country's leading drugs-misuse experts, has told The Scotsman he believes the government has made a serious mistake by failing to impose targets for reducing the national reliance on methadone.

He believes addicts should have a maximum of two years on methadone, which is prescribed to an estimated 22,000 people as an alternative to heroin.

Only with such targets will ministers be able to shift enough money into improving the residential rehabilitation facilities that are desperately needed to successfully tackle the country's drugs problem, he says.

"The worry is that we have a very impressive looking drugs policy that is forward-looking, but that local practice diverts from it in fairly major ways," Prof McKeganey, director of the Centre for Drugs Misuse Research at Glasgow University, said.

There are an estimated 50,000 "problematic" drug users north of the Border – a level of addiction Prof McKeganey says is "ripping the heart out of Scotland".

He wants ministers to be much more proactive in delivering changes to drug treatment to reverse the tide of addiction.

"You would have to be enormously optimistic to believe with an absence of targets you could bring about the order of change in the drugs strategy that is outlined.

"At the minimum, there needs to be a much clearer setting-out of the benchmarks to ensure the strategy is influencing things on the ground. Unless ministers say what order of reduction in methadone, whether it's 10 per cent year or 20 per cent they want to see – something which would then release funds for other services – then it is unlikely they will achieve what is a major new direction in drugs policy, away from the McConnell years."

Jack McConnell, the former Labour First Minister, was accused by political opponents of presiding over an explosion in methadone prescription, which critics claim serves only to replace addiction to illegal drugs with addiction to a legal substance. Those concerns were backed by figures in 2007 that showed the number of drug addicts receiving prescriptions for methadone had risen by 35 per cent over five years.

In an attempt to break from the past, the SNP's drugs strategy, published last May, aims

to ensure all treatment and services are geared towards helping addicts become drug-free.

Some 94 million will be spent on drugs treatment over the next three years, with health boards getting an extra 3.8 per cent for their drug budgets.

But one of the problems ministers face is that it has never been clear how much is actually spent tackling drugs because of different programmes being funded by different parts of government. Robert Black, the Auditor General, will produce a report this spring explaining how much is spent by which departments, and that is expected to inform the future spending decisions.

Prof McKeganey says that, nine months after the strategy was unveiled, evidence has yet to emerge to show it is making any difference. He referred to figures published last November showing the amount spent on prescribing methadone in Scotland had increased by 20 per cent on the 2007 total of 21.5 million.

Prof McKeganey's call for national methadone targets was backed last night by the Scottish Conservatives.

Bill Aitken, the party's justice spokesman, said: "We would acknowledge that there is a strategy in place and in time this will improve matters. However, I do think that a much more robust approach is needed. We cannot simply keep people on a heroin substitute for years at a time."

Fergus Ewing, the community safety minister, insists methadone prescription should be left to clinicians without interference from government. Instead, he wants to provide a wider range of services to allow drug addicts to get the help they need to become clean without having to wait several months.

A Scottish Government spokesman said:

"We want recovery to be the aim of all drug treatment and rehabilitation services.

"We need a wider range of services in place than there has been in the past. We should not be over-reliant on any one form of treatment over another."

A clear path to more rehab centres will help get addicts clean

PRESCRIBING methadone is something of a delicate balancing act.

Most GPs are involved in issuing methadone and we have concerns that these patients seem to keep going on and on and on.

But if you start enforcing a reduction in the levels of methadone, you might find they are buying drugs from the private sector off the street and having to finance that through crime. Are you really solving the problem or are you moving it on and causing an increase in shoplifting, robberies and other crime?

It's not as easy as saying you must be reducing methadone to nothing after two years. But there is a need to reinvigorate the methadone problem. We need to do something about it. I think we need more residential places. When drug addicts come to me and say I really want to get off drugs, they want to be locked away from it so they can get through the traumas of withdrawal and get clean and then try to rehabilitate their lives.

It's very difficult when you are still on the streets, seeing mates.

The provision of different services tends to be very ad-hoc. It can be hard knowing what is out there and how to access it.

You hear about drug users saying they have got a mate who has gone to one agency, or one particularly voluntary group. It's very confused. Some services are health-funded, some are social-funded, some voluntary-funded.

I have got a patient going down to Brighton, where there's a residential facility that takes children. Patients can face a wait of six to 12 weeks before they can see someone at the local Community Drugs Problem Service.

If they are desperate for help, that's really unhelpful. That means the resources are not there to stabilise them and to tackle their drugs misuse.

Dr John Garner, a GP in North East Edinburgh.

Tycoons urged to fund Italian-style solution

SCOTLAND'S business titans have been urged to fund a new drug rehabilitation centre based on a successful facility in Italy.

San Patrignano is the largest drug rehabilitation centre in the world, located just outside Rimini in the Emilia-Romagna region. Set up 30 years ago, it is now home to about 1,800 recovering drug addicts, free of charge.

Professor Neil McKeganey said the centre has delivered stunning results and believes Scotland's mega-rich should finance a similar venture. "I think some of Scotland's private financiers could do more," he said. "I'm not sure that if drug treatment is left in the hands of government, we won't just end up with a national methadone programme as opposed to an inspirational recovery community."

San Patrignano earns its income from the variety of enterprises it has set up to provide those being rehabilitated with job training and a sense of meaning and dignity.

Since 1978, it has provided more than 20,000 people with a home, free medical and legal assistance, the possibility of continuing their studies, job training and having the opportunity to change their life.

Recent studies by several universities show that 72 per cent of those who completed the programme at San Patrignano are fully re-integrated into society and remain drug-free.

A similar proportion of people who complete the programme end up working in the field for which they have received training, and the relapse rate is less than 8 per cent.