PI Brief Update

Does the Human Rights Act Apply to Alcohol Dependant Patients? - Dr Mark Burgin

28/05/24. Dr. Mark Burgin BM BCh (oxon) MRCGP explains that the failure to provide benzodiazepines for harm reduction in Alcohol Dependant Patients may breach Article 3 of the HRA 1998.

Alcohol is a potent anxiety reducing drug that has a narrow therapeutic index (the ratio between an effective dose and a harmful dose) and is likely to have no safe dose that is also effective.

There have been attempts in many countries to ban its use with variable outcome most notably prohibition in the USA 1920 to 1933.

Alcohol is relatively easy to make from yeast and sugar (legal) and can be concentrated easily in a freezer (illegal) making control of production impossible so most effort is focused on sales.

Taxation and restricting the number of places that alcohol can be sold (Licensing Act 2003) have become less effective at controlling the consumption leading to interest in minimum pricing.

The ineffectiveness of legislation to control the percentage of alcohol such as the progressive alcohol duty has lead to increasing strength of popular products and associated harm.

Harm from alcohol

The Government provides figures which confirms that there are about half a million dependant drinkers and about 8000 die per year from alcohol related deaths in England (1).

These figures are likely to underestimate the numbers as community studies of alcohol usage only detects half of the alcohol sold and death certification of alcohol is patchy.

In 2016 there were 2,593 drug misuse deaths (2) although this does not include deaths from viral diseases transmitted by sharing needles.

Alcohol’s pharmacological action is on the GABA receptor which decreases brain activity but its toxicity comes from its ability to kill cells so alternatives have been found that are safer.

As damage from alcohol is cumulative and associated with overall alcohol usage so measuring the numbers of relapses underestimates the effectiveness of Benzodiazepine substitution.

Foetal alcohol syndrome is a major cause of congenital deformity and learning difficulties where even a small reduction in alcohol consumption could have benefits.

Alternatives to alcohol

The first Barbiturate was discovered in the 1864 but it was not until 1903 that it was marketed as a sleep aid and various barbiturates were used widely until the 1970s.

Barbiturates were recognised as highly effective preventing much of the discomfort of alcohol withdrawal but shared alcohol’s risk in overdose.

In the 1960s benzodiazepines such as Diazepam were approved for use and rapidly replaced barbiturates as a safer alternative although they are not as effective in preventing withdrawal.

There are no antidotes to Barbiturates and although benzodiazepines are not completely safe in overdose their effects can be reversed by use of an antidote Flumazenil.

The medical profession has not increased its use of benzodiazepines (4) or widened the indications through guidelines and because of increasing awareness of the potential for abuse.

Benzodiazepines have no licenced indication for the long-term treatment of alcoholism so published research is lacking although they are commonly used for this purpose in Primary care (5).

Human Rights

The prison service faced a legal challenge in 2006 over their policy of detoxification (cold turkey) even when the prisoners had been receiving methadone replacement in the community.

The High Court decision in Goodale v The Ministry of Justice (unreported) was based upon Article 3 of the Human Rights Act that opiate detox was inhuman or degrading treatment.

Alcohol addiction is associated with the same types of social breakdown, health issues and disability that have led to harm reduction programs in treatment of other addictions.

Alcohol treatment programmes are focused on detoxification and then abstinence which has lower effectiveness than replacement programs in the treatment of other drugs.

The medical profession is understandably reluctant to take a stand in an area as politically charged as alcohol but stigma and workload may also be important factors.

Any Human Rights Article 3 challenge is most likely to succeed with pregnant alcoholics where replacement of alcohol with benzodiazepines would reduce foetal harm.

Conclusions

As a doctor working in South Yorkshire I have seen the long-term consequences of medical and public policy on alcohol on individuals, their families and their communities.

My advice to any doctor considering treating alcohol dependant patients with long term benzodiazepines is that they should not as there is no clinical indication for this use.

Although I believe that there are circumstances that a doctor would be acting in the patient’s best interest in giving this treatment, doctors must put the law above their duty to the patient.

Doctors who want to change the law should work through their professional bodies, writing articles and writing reports for patients who have suffered harm from this policy.

The easy access to alcohol through legitimate means (buying at supermarkets) as well as the social norms of drinking has allowed a blind eye to be turned to the Human Rights of this group.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

1. Health and Social Care Information Centre (2017) Statistics on Alcohol, England 2016
2. Deaths related to drug poisoning in England and Wales: 2016 registrations
3. nhs.uk/conditions/alcohol-misuse/treatment/
4. Health and Social Care Information Centre. (2016) Prescriptions dispensed in the community, England 2005–2015. (HSCIC)
5. Recent Dev Alcohol. 1989;7:283-313. Benzodiazepines in the treatment of alcoholism. Nutt D (1), Adinoff B, Linnoila M

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