Public health figure calls for more rehabilitation units as a longer-term drugs strategy

APIONEER of Scotland's methadone programme has warned that more resources need to be invested in alternative services which help addicts come off drugs. Dr Laurence Gruer, a leading public health expert who was responsible for setting up the methadone programme in Glasgow more than a decade ago,saidthere has been a"lackof balance"intheapproachtakento solving drug problems in Scotland.

While harm reduction programmes havebeensuccessfulinpreventing epidemicsof crime and disease,he argues that more money shouldbe invested in expanding rehabilitation services to help addicts stay off drugs once they return to the community.

Gruer's comments are the latest in the ongoingdebateovertheuseofthe methadoneprogrammeinScotland. Figures show the number of prescriptionsfortheheroinsubstitutehave quadrupledinadecade,andrecent tragedies involving children overdosing on the drug have sparked major concern.

Speaking ahead of a conference titled The PunitiveSociety, being held tomorrow in Glasgow by the Scottish Association for the Study of Offending, Gruer toldtheSundayHeraldthatharm reduction measures implemented in the 1980s had succeeded in reducing rates of HIV and had been an effective crime prevention initiative.

But he added: "Looking at the methadone approach in the longer term, there are major issues. What we have are thousands of people who may be somewhat better off than when they were injecting, but they are still addicted to drugs.Wehaven'thadenoughresourcesputintohelpingpeoplecomeoffdrugsaltogether-therearen'tenough rehabilitation units, which can help a proportion of people to stop drugs altogether."

More than 20,000 people in Scotland - nearly a third of theaddictpopulation- are currently being prescribed methadone. Gruer, who is director of public health science at NHS Health Scotland, said that it had been easier to expand the methadone programme over the years than to invest "tensofmillions"intobuildingup rehabilitation services.

Buthe cautioned that to abandon harm reduction measures altogether would be a "disaster". "It's a bit like saying you treat people for diabetes by giving them insulin every day, but you haven't cured the illness," he said. "You can't say we will stop giving people insulin because it hasn't cured them, because you will get people dying.

"In the same way, if we stop people getting methadone, then suddenly we will have thousands of people on the streets desperate to get street drugs, a crime epidemic and an increase in HIV."

In 2005, two-year-old Derek Doran diedafter drinking methadone in his parents' home, prompting First Minister Jack McConnell to launch a review of Scotland's methadone programme.

Further questions over the use of the heroin substitute were raised in the wake of research by drugs expert Professor Neil McKeganey, which revealed that fewer than 4% of heroin addicts who are given methadone are drug-free three years after beginning treatment.

David Liddell, director of the Scottish Drugs Forum, agreed that more should be spent on rehabilitation services, but warned that it would require a commitment for "substantial investment".

"It is the old story. We need to invest to save in the long term. We are helping to keep people alive and manage their situation,and of course, in an ideal world, we need to do an awful lot more."

Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action Teams, said that the harm reduction model had been the answer in the 1980s amid the threat of HIV and Aids "but the next step is to try and offer a range of effective rehabilitation programmes".