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Just give me the pill...

Features | June 2016

Mark Whitaker found his GP strangely reluctant to prescribe some useful medication that could have helped him cut down on his drinking. Why?

Not knowing when to stop: Hogarth's 'A Midnight Modern Conservation', c1732

I am pretty sure that I am not an alcoholic but I am equally pretty sure that I am somewhere on the ‘problem drinker’ spectrum. I hardly ever drink during the day, and continue to lead a creative working life, but every evening without fail, starting at 6 or 6.30pm, I drink at least a bottle of wine, if not a bit more. I do not get drunk in any obvious way, but – I am reliably and frequently informed – I can get boringly bombastic, intolerant of disagreement and too quick to take offence.

In other words I am just like tens of thousands of late-middle aged men in Britain (I am 69) with a wine habit. It causes serious rows with my wife, it costs me lots of money and it seems it could cost the NHS lots of money in the future if I do not cut down. Traditional detox programmes, premised on achieving total abstinence, have always seemed irrelevant to me, so I was fascinated and encouraged by reports last year that Nice – the National Institute for Health and Care Excellence (Nice) – was ‘minded’ to give the green light for the NHS to prescribe a new drug called Selincro that suppresses the desire to drink alcohol.

It was after a particularly nasty row with my wife in late November that I decided to see if it was available. I phoned the local GP surgery and (remarkably) got an appointment later that same day. It was with a doctor I had never met before. He was perfectly pleasant … and entirely unsympathetic to my request. Despite the fact that we were meeting on the very day that Nice was issuing its final and positive recommendation on Selincro, the GP insisted he knew nothing about any ‘pharma’ initiative to help with problem drinking, and expressed his scepticism as to whether it could work.

 I had to recognise, he said, that dealing with drink was a question of character, not of chemistry. ‘Don’t expect a pill to do the work for you’, he insisted. It is a phrase I have come to be all too familiar with over the past few months.

My next step was to make an appointment with another GP whom I have known, and liked, for 25 years. But my request for some Selincro fell on equally resistant and moralistic ears. ‘Wouldn’t it be best if you just stopped drinking altogether, Mark?’ he said. ‘In any case, don’t expect a pill to do the work for you.’ He also insisted that any prescription for the drug was dependent on my signing up for ‘psychosocial counselling’ with the local ‘Substance Misuse Service’. 

This, with some reluctance, I did, and a few weeks later I spent an hour talking to a pleasant enough young woman about my drinking and why I wanted to cut it down. She was not entirely dismissive of Selincro, but was clearly uncomfortable talking about it and of course urged me ‘not to think that a pill could …’ We made an appointment for a fortnight later, and as I left she handed me some literature to read and think about. I was incensed by it. It was as though the Danish pharmaceutical company Lundbeck had not spent tens of millions of pounds developing Selincro, that clinical trials had not shown that it could reduce alcohol consumption by up to sixty per cent, and that it was not already available in Scotland and across continental Europe. What I had been given to read was all about detox programmes. If I followed one, I was assured, I would start to feel ‘more healthier’. Oh dear.

Why such reluctance to allow me access to a drug that Nice had concluded was value for money for the NHS? After all, no doctor in my experience has prescribed me an antibiotic or a painkiller while saying at the same time that I should not expect it to do what it was designed to do. (I have recently recovered from a nasty bout of cellulitis: should I attribute the infection’s eventual retreat to my moral character and willpower rather than ten days of intravenous antibiotics?) The more I have read about Selincro the more furious I am that my local NHS refuses to acknowledge that the drug’s whole raison d’être is to provide an alternative to the detox route. Welcoming Nice’s decision to allow NHS doctors in England and Wales to prescribe it, Jonathan Chick – consultant psychiatrist and honorary professor at Queen Margaret University Hospital in Edinburgh – wrote that this would help ‘people to cut down drinking to less harmful levels when they are not ready and have no medical need to give up alcohol altogether. This may help us to engage many alcohol-dependent patients that we know are not currently receiving help’.

'I had to recognise, he said, that dealing with drink was a question of character'

I thought I might be one of those patients: but four months after first reporting myself to the local GPs I have received no help whatsoever. Quite the opposite. The local Substance Misuse Service was privatised in February, and I have never been offered an appointment by the new ‘provider’, despite my twice phoning them to enquire about one. I could, of course, bypass the NHS entirely and buy my own stash of Selincro online. Its current price is £3.48 a pill. So if the drug succeeds in reducing my wine consumption by fifty per cent, and if my daily bottle of Côtes du Rhône costs £7, then the Selincro will pay for itself. But even online you have to get a prescription for the drug. This means filling out forms, submitting to a ‘consultation’ and providing evidence of a fortnight’s alcohol consumption. And to be honest, given that any drug might have unexpected side effects, I feel safer getting it from a doctor than from a website.

But more sadly the GP surgery seems to hope I will quietly forget about my request for Selincro. It is ignoring it. Exactly a month ago I wrote a courteous letter to the GP I know well telling him that my compulsory ‘counselling’ seemed to have fallen between the cracks in the privatisation process. But I also – and I suspect this is what has infuriated them at the surgery – pointed out what I see as the contradictions between what Selincro was meant for and the way the local practice has viewed it. I mentioned that the National Institute for Health Research had said that one of the drug’s advantages was that there would be less need and demand for existing counselling services, and that the manufacturers, Lundbeck, were developing an online ‘psychosocial support tool’. 

In other words, finger-wagging detox-wallahs would not be needed, and maybe that is what they cannot take. I have had no reply to my letter. All I ask is to be treated as a grown-up and given a pill for grown-ups.