Health Correspondent Barry Nelson talks to Dr Tom Carnwath, who believes the current methadone-based treatment programmes are failing some drug addicts - and is suggesting a radical alternative.

THE idea of doctors doling out NHS heroin to injecting drug addicts takes some getting used to. But at least one North-East medic is hoping that he will be able to start doing just that in the near future - with the Government's blessing.

Dr Tom Carnwath, a consultant psychiatrist with County Durham Priority Services NHS Trust, is one of the UK's leading experts on the management of drug addiction. He is also one of just 70 doctors in the country with a Home Office licence to prescribe heroin.

Last year, Dr Carnwath co-wrote a book called Heroin Century, in which he argues that heroin is dangerous principally because it is illegal. He suggests that a more relaxed relationship between society and the drug would benefit both the economy and public health and safety.

While there is no realistic prospect of heroin being legalised, Dr Carnwath is hopeful that the North-East will become one of a number of pilot sites to discover whether giving hard-to-manage heroin addicts a guaranteed legal supply of the drug they crave will benefit them and society as a whole.

While the region still lags behind some of the larger cities in the UK, Dr Carnwath says the number of heroin addicts in the North-East is steadily rising, including users who live in small towns and villages.

Recently two specialist clinics to treat drug addicts were established on Teesside but it is understood that both are based on methadone treatment programmes.

Like a number of specialists in his field throughout Europe, the Darlington-based doctor believes a more enlightened approach to heroin can work. Apart from helping the addict to become more stable, Dr Carnwath believes it would undoubtedly reduce the amount of drug-related crime.

He points to recent research which suggests that 90 per cent of the crime committed by heroin addicts is carried out by ten per cent of the users.

"We found around half the addicts were not involved in crime at all, so you can see that stopping heroin addicts stealing is not a complete panacea for reducing crime," he adds.

In the long-term, the objective remains to wean the addict off the drug dependency and back to health.

The Government would like to see more doctors prescribing heroin to addicts who do not respond well to the standard treatment, methadone.

The problem is that most GPs are unwilling to take on heroin addicts, the specialist treatment services are very limited and the number of doctors actually entitled to prescribe heroin is minuscule compared to the problem.

RecenT studies carried out in Switzerland and Holland suggest that prescribing heroin to dependent users can lead to improvements where other treatments have failed, including better physical and mental health, a reduction in illicit drug use and crime and an increase in those who are able to return to employment. But British experts would like to see more home-grown research: there is very little hard UK evidence to show that putting addicts on heroin is an effective way of managing them.

Dr Carnwath believes a North-East pilot scheme is definitely on the cards. Following a successful grant application, the National Treatment Centre in London plans to set up pilot centres around the UK to test out the heroin treatment theory.

"We would certainly be very interested in the North-East and I think it is very likely we will get one of the pilot centres," says Dr Carnwath, who was part of a team of experts which produced a recent report for the Joseph Rowntree Foundation charity.

The report acknowledged the strength of the case for wider heroin prescribing but pointed out that most UK doctors are likely to require better evidence of the effectiveness of prescribing heroin to addicts before they help the Government to put plans for wider access into effect.

In particular, the report calls for major research trials "that will evaluate its effectiveness compared to other treatments".

Only around 70 doctors are allowed to prescribe heroin, so when you compare that figure to the estimated 200,000 population of "problematic" or dependent heroin users, the mis-match becomes only too apparent.

So how do we move from a situation where only 448 problem users in the whole country were receiving regular heroin on prescription when a survey was carried out three years ago?

Dr Carnwath and many other specialists in his field would like to see changes to the licensing system to allow a two-tier approach. This would mean that the decision to begin injecting an addict with heroin would remain with a specialist but a second tier of licensing would allow non-specialist doctors to maintain addicts on a heroin treatment programme.

Such an approach could allow far more doctors to get involved in the messy but necessary business of treating the increasing number of UK addicts.

Ironically, since he moved across the Pennines from his former base in Manchester 18 months ago, Dr Carnwath has not used his powers to prescribe heroin. He says he is concentrating his efforts on improving methadone-based treatment for heroin addicts across County Durham, with an emphasis on involving more ordinary GPs.

He is currently working on a project which could become a model of how to manage drug addicts. "Before I came to Darlington we were seeing all the steady users and there was a huge waiting list of around 150 for the unstable people who were having trouble. All the difficult patients were being looked after by the GPs."

Dr Cornwath is determined to reverse this pattern and with the agreement of three Darlington practices the specialist drug misuse team is now looking after the more complex cases while the GPs look after more stable drug users. He is hoping that word will spread that the new approach is working and that more practices in the Darlington area will come on board.

DR Carnwath would also like to see a more realistic approach adopted to treatment for heroin addicts. "All the evidence is that you have to keep people on treatment programmes for two to three years before you make progress," he says.

The shortage of doctors able to prescribe heroin caused practical problems for Dr Carnwath when he moved to the North-East from Manchester.

"When I moved here, I still had 30 patients on heroin back in Manchester and at first there was no-one to replace me," he says. "Some people were travelling a long way to see me. I had at least one patient who was coming up from Kent."

If a heroin pilot scheme does get underway in the region he suspects that it may have to provide overnight accommodation. "Unlike methadone, you have to inject heroin three or four times a day," he says.

Overall, Dr Carnwath suspects that UK research will show that heroin prescription is beneficial for addicts and can reduce crime but he believes that methadone - a synthetic heroin substitute which is taken orally rather than injected - will remain the main treatment for addicts.