Risks from forced detoxification from heroin are being ignored, conference hears.

Changes of policy on provision of services to drug users risk forcing thousands of people into detoxification and abstinence programmes before they are ready, a primary care specialist in drug misuse has warned. The potential consequences could be fatal. Steve Brinksman, a GP from Birmingham and clinical lead of the support network on Substance Misuse Management in General Practice, told a meeting in Manchester that the recent shift in emphasis away from harm reduction and stabilisation towards a more recovery based approach should not be allowed to go too far. " Detoxification is not a cure for anything, " he said. " It is a small step in the process, and if you do not do the preparation beforehand or the aftercare afterwards you are setting people up to fail and you will increase their risk of dying. " Don't get me wrong: I'm all for recovery, and the ultimate harm reduction is abstinence. But people are not Superman. It's not a case of with one mighty bound they are free. There are a lot of steps. Harm reduction takes that on board. " The " recovery agenda " was adopted as official policy in the government's drug strategy last year (BMJ 2010;341:c7168, doi:10.1136/bmj.c7168). Although it stopped short of the abstinence based approach proposed in the Conservative manifesto, the policy emphasised a focus on helping addicts overcome their dependency rather than on providing maintenance methadone and clean needles. Dr Brinksman acknowledged that nobody should be " parked " on methadone for years but said that he was worried that the pendulum was " swinging too far the other way. " " At the moment we have a government and a media who seem to think that recovery is for everybody. They want to know why everyone isn't in rehab — why aren't they all getting better. Well, actually the problem is a bit bigger than that. " He warned that if drug services became too preoccupied with abstinence they risked returning to the " revolving door " policies of 20 years ago. " Patients used to come in for treatment, and six weeks later they'd be back again. And we had a prison system that was doing exactly the same thing. We don't want to go back to that, which is where harm reduction comes in, " said Dr Brinksman.