Greetings all from Berlin

Just attending my 1st Stapleford conf am am impressed by the quality of the speakers & presentations ... almost become pro implant

Told you before they aren't all bad.

I've been to two stapleford conferences. You get to hear some different perspectives. I thought that it had ceased to exist due to the GMC case

Jim
You may be restricted in what you can say but do you know where the Stapleford case is up to?
Simon

Coincidentally it's just appeared in Saturday's Guardian, page 12. (try as I might I can't get it on web yet - think it's too soon -here's a link from the Telegraph: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/20...06/03/25/ixhome.html. Looks like cases against 4 docs have been dismissed, but the other 3 still to be heard, Drs Tovey, Brewer and Kindness. Dr Brewer is in for most criticisme in the article, has been found to have acted irresponsiblu and innapropriately in 13 cases - headline reads "Pioneering heroin treatment doctor may be struck off". No indication as to when the decision will be made re disciplinary action.

There may be more on the GMC site

http://www.guardian.co.uk/drugs/Story/0,,1739342,00.html

the guardian seems to have the clearest description so far, though I imagine more information must be available elsewhere.

From what has been reported and the charges on the GMC site it rather looks like their practice was way outside accepted guidelines and reflects the restricted way in which private practice has to operate. I can see why a complaint would follow such a death.

What is different from ther earlier reports is the way the media are presenting it. Last year it was being put as an issue of abstinence-oriented treatment via methadone reduction regimes versus maintenance.

However difficult things may now be for Stapleford and Dr Brewer, at least the media have got off that particular bandwagon, perhaps because it now has a better target, those evil drug-using parents who should have only a year to get clean.

Hi everyone,

been lurking around the forum for a while (I think the site is a great resource for both patients/ service users & professionals) and I have some information on the stapleford case that may interest some of you.

Firstly let me say that I was once a patient of the stapleford center and was prescribed one of the 'home detox kits' that's one of the things causing all the fuss. This was a number of years ago and I'm not going to get into the in's and out's of private addiction treatment (not at this time of the morning anyway!!) but the center did nothing but help me overcome the problems I was having at the time, and the instructions I was given were pretty straight forward...

Anyway I have 7 documents from the GMC with the panels findings of fact, I've only had chance to look through most of Dr Brewers doc but there is plenty of extra information in there to get a good picture of what was going on and the charges and findings against the seven. I'm not posting them up anywhere as I'm not sure if they are a matter of public record or not, so if you want a copy I will email them to you privately. I might be getting hold of the actual whiteness transcripts as well, but not until the case is over completely, it resumes in July this year. if and when I get them I'll let it be known and you can have a copy of them as well.

From what I have read so far the justification for some of the combinations may have been difficult, I'm not going to get into amounts prescribed because titrating for tolerant people is relative, but some of the findings against Dr Brewer's monitoring of patients is nothing I haven't seen the shared care NHS system of doing. That said I wish he had been extra vigilant as he must have known that his treatment philosophy was at odds with the established view. But let me also say that the 'established' system is not exactly a resounding success story (although I know as much as anyone else this is a hugely complex and difficult problem and any professional working in the filed should be given credit for doing so) so surely people doing things differently can only be a good thing.

Anyway, anyone who wants the doc's email me and I'll get them to you post haste.

Many thanks, David.

david.shave@gmail.com

quote:

Originally posted by jimjones:
From what has been reported and the charges on the GMC site it rather looks like their practice was way outside accepted guidelines and reflects the restricted way in which private practice has to operate. I can see why a complaint would follow such a death.

What is different from ther earlier reports is the way the media are presenting it. Last year it was being put as an issue of abstinence-oriented treatment via methadone reduction regimes versus maintenance.

However difficult things may now be for Stapleford and Dr Brewer, at least the media have got off that particular bandwagon, perhaps because it now has a better target, those evil drug-using parents who should have only a year to get clean.

I'm aware of one patient some years ago who was given two weeks to "detox" in the community or go into hospital for titration. Apparently the latter was botched up and from a 'shakey' 80mg daily, he was reduced to 60mg o.d. for 6/12. The reduction was explained that he was using methadone for the wrong reasons, viz. that anxiety was his problem. He was already on 40mg of diazepam, yet he had never asked for any anxiolytic. I believe the case had a happy outcome, however, with the arrival of an SI-GP who understood the situation.

Hello Judith:
To quote from The Guardian, dated 25th March 2006:
"Sarah Boseley, health editor
Saturday March 25, 2006
The Guardian


A world expert on the treatment of heroin addiction may be struck off the medical register after the General Medical Council decided yesterday that he had been irresponsible in the way he prescribed opiates and other drugs to some of his patients.
The GMC's findings will dismay those who think Colin Brewer, founder of the private Stapleford Centre, and his colleagues were saving heroin addicts from crime and destitution by maintaining them on opiates over long periods. Some of their patients say they have been able to lead normal lives for years as a result of the treatment. But the GMC's fitness to practise panel yesterday found that Dr Brewer had acted irresponsibly and inappropriately towards 13 of his patients. It will meet again to decide whether to strike him off the medical register.

One of the Stapleford Centre patients died during a "home detox" undertaken at Dr Brewer's suggestion. The patient, referred to as Mr GS, 29, and his mother were given an instruction sheet and 10 prescription drugs to sedate him and ease withdrawal. The mother failed to realise from the instructions that the patient had to be watched 24 hours. The man vomited in his sleep and choked to death.

The GMC was highly critical of the programme, which put the patient in charge of the drug dose and offered medical support only at the end of a telephone. The panel "did not consider this was a safe or suitable method of managing a patient who was being treated with large doses of potentially dangerous drugs and supervised by untrained carers. The instruction sheet was complex, unclear, confusing and inadequate.

Many of the findings relate to the practice of giving patients long-term prescriptions with the result that they had large quantities of drugs which they may have been tempted to sell. One patient, referred to as Mr RB, was given a five-week supply of the opiate Phenazocine, which amounted to 1,050 tablets. Later he was given 28 days' supply of Palfium, which came to 1,120 tablets. The panel ruled that Dr Brewer should have told the Driver and Vehicle Licensing Agency that another patient, Ms ST, was driving while under the influence of drugs. She had four car accidents. Another addict had anorexia nervosa and at one point her weight dropped to six and a half stone, yet Dr Brewer failed to treat her for it....."


I have yet to see a medical article in a national newspaper - ever - to not contain medical/clinical errors so I take the above with a pinch of salt over both shoulders twice daily! . Even if(and I question it) there was a basis in clinical pharmacology, the most important factor was overlooked - based solely on the above article, which is probably a great simplification, - the patient's family should have watched him very closely indeed, and this ought to have been made pellucid. I'm sure that in withdrawal, or under sedation, counting tablets is not a precise thing, and giving out the medication ought to have been left to a person/s who understood the instructions & could do basic arithmetic. Also, giving phenazocine, followed by short acting (?2hrs) Palfium/Dextramoramide (can one still get it on private prescription?) sounds unusual, though I can understand using it for a 'smoother' withdrawal. Methadone is very good for maintenance, but due to binding to miscellaneous receptors as well as opioid receptors, it usually takes a long time to withdraw from it and that can make it too unpleasant for some. Those who are also dependent on benzodiazepines could be helped, in my personal opinion, by a short-term rotation of drugs which work synergistically and in different ways, so that patients don't become dependent on one specific group of drugs (hopefully not all of them either!). This should also be left to someone who can do this. If there is nobody to understand and supervise this then it would be best done in hospital. Perhaps one could use diphenhydramineHCl for amtiemesis plus, say, some chlormethiazole initially, then rotate mixtures of a sedating antidepressant with some chloral hydrate, then perhaps chlorpromazine. Then tail off the chlorpromazine according to weight. Perhaps keep it longer in an anorexic and shorter in those of healthy BMI or obese.

The anorexic of six and a half stone is pushing one's luck and, if true, I would not be happy with it, and would try chlorpromazine plus or minus cyproheptadine to boost appetite. [an old, sedating antihistamine which also increases appetite]Note: all doses according to response and/or side-effects.

I keep an open mind on this, and if I'm talking nonsense, please tell me .

Janusz