Only specialists will be able to prescribe methadone to drug users, according to new government guidelines.

The move is part of an effort to improve treatment of drug users and to cut overdoses and leakage of methadone onto the black market.

Official figures show there were 247 drug-related deaths in England and Wales in the last six months of 1997.

Half of them were being treated for drug misuse.

The new Drug Misuse and Dependence guidelines are a response to a review by a medical working group of 1991 guidelines, known as the Orange Book.

Prescribing controlled drugs

The new guidelines advise that only doctors with specialist training and knowledge should prescribe controlled drugs, such as methadone, to misusers.

They also emphasise:

• The importance of GPs and drug agencies working together in the care of drug misusers
• The importance of fully assessing a patient's needs and, where necessary, gradually introducing methadone
• That drug users should take methadone under supervision and have their medication prescribed on a daily basis to improve patient compliance

Announcing the new guidelines, public health minister Tessa Jowell said: "Drug misusers can be a difficult group to treat.

"They need special care. These guidelines will help ensure that doctors have the skills and the back-up to treat drug misusers with both confidence and the minimum of risk."

She added that more GPs would feel able to treat drug users if there were closer partnerships between them and drug specialists.

Primary care

The government has announced a �271m cross-departmental package for dealing with drug misuse over the next three years.

Methadone should only be prescribed by specialists, says the government

Some �50m of this will go to health authorities. Ms Jowell said one priority for this money would be to support primary care workers treating drug misusers.

Ms Jowell also said that tightening up methadone prescriptions would "ensure that only doctors who are properly trained and supported will be involved in treating drug misusers".

She added that it would help eliminate inappropriate prescribing which could lead to overdose and prescribed drugs leaking onto the black market.

The guidelines also propose that all private prescriptions of methadone should require a licence.

Dr Mark Ashworth, a GP at the Hurley Clinic in Kennington, south London, where the working group report was launched, said standards of care varied across the country.

His clinic specialises in treating drug users.

He said: "One of the things these guidelines will do is to bring the treatment of drug users right into the core of primary care." He added: "One of the hardest things can be accepting that some people are never going to get off drugs and, rather than curing them of their addiction you can keep them at a steady level of methadone for a long time. But treatment does work."

The British Medical Association said it had published a report on misuse of drugs in 1997 which proposed closer partnership between GPs and specialist agencies.

The report says drug users problems tend to be "multifactorial" and can include psychological, social and other problems.

It also says that training for GPs has "long been neglected" and depends on where you work - despite the fact that there is a greater need than ever for it because of rising numbers of addicts.