Residential rehab places taken by Dutch addicts

Residential drug rehabilitation places at one of Scotland's leading addiction hospitals are being taken by Dutch heroin users because authorities in Scotland will not pay to use them, preferring to put addicts on methadone instead.

Peter McCann, chairman of Castle Craig Hospital in Peeblesshire, told The Observer that Scottish addicts were missing out on the best care available because of an obsession with meeting Holyrood methadone treatment targets, despite 'overwhelming' evidence showing that the drug is 'ineffective'.

McCann said that at the private Castle Craig hospital up to 30 beds for intensive detox and long-term care which should be available at any one time for home-based addicts - at a cost of £800 a week paid for by their health authorities - now go to patients from the Netherlands. With only 300 residential rehabilitation places available across Scotland, this represents 10 per cent of the total.

'The take-up for these places from authorities in Scotland is extremely poor and has been for a number of years now,' McCann said. 'We have an excellent reputation around Europe, and as a result we fill the beds with people from the Netherlands, where health authorities are happy to pay for the rehab here.'

A study by the Centre for Drugs Misuse at Glasgow University concluded that one in three heroin users who had residential treatment was drug-free after three years. But only 3 per cent of those who were just on methadone were clean after the same treatment period.

The head of the centre, Professor Neil McKeganey, said: 'Residential rehab is expensive, but where is the economic sense of providing a treatment that is ineffective. Methadone is cheaper - but it is not working.'

McCann traced the decline in uptake of places to the year 2000 and the establishment of the Alcohol and Drug Action Teams. These partnership organisations, which are paid for by local government, the NHS and the police, were set up to tackle the joint issues of alcohol and drug problems prevalent in Scottish society.

He said: 'Methadone has proven to be next to useless in terms of getting people off drugs, but it seems to satisfy their need to meet targets for care, and this would appear to be more important than whether they are useful or not.'

But Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action Teams, argued: 'There is a lot of evidence in support of methadone - it reduces the amount of chaos in an addict's life and does help. However, it is a tourniquet which if left on too long can leave you with gangrene. We have to develop our other support services as well.Residential rehab is the Rolls-Royce treatment, and while it is good for some people it is not good for others. It is also very expensive - which is why we are investing in community-based care. Castle Craig is a fine institution, but it is also a private business and our budgets are finite.'

The anomaly at Castle Craig emerged close to the second anniversary of the death of two-year-old Derek Doran, who drank 50ml of his mother's methadone at their home in Elphinstone, East Lothian. This tragedy in December 2005 and other high-profile cases involving children spurred the then First Minister, Jack McConnell, to order a major review of the way Scotland deals with heroin users and led to a report critical of the lack of support given to those prescribed methadone.

But the study came down in favour of the methadone programme as the cheapest and most effective treatment available.

McKeganey said that 'nothing has changed' since Derek Doran's death, and there were thousands of children who remained at risk.

There are 51,582 known heroin users in Scotland. A third of these are believed to be caring for children under the age of 16.

Source: Thomas Quinn
Sunday December 2, 2007
The Observer