Detox clinics doling out too many drugs and risk killing patients

Staff are doling out too many drugs at rehab centres and carrying out detox so badly they risk killing patients, watchdogs have said.

Inspections by the Care Quality Commission found more than six in ten clinics for alcohol and drug problems were not safe, with residents at risk of liver damage because of poor drug control.

The regulator expressed “deep concern” and called on every clinic in the country to review its practices, after finding a litany of risks to those entering residential rehab units for those battling alcohol and drug problems.

Such clinics, run by the private sector, are best-known for providing detox clinics for the rich and famous. But they also provide the majority of services funded by councils, to prescribe medicines such as methadone and benzodiazipines for those withdrawing from alcohol or drugs.Such drugs are supposed to be carefully controlled, because they are so addictive.

In some units, doctors were found to be prescribing controlled drugs by telephone to clients they had never seen.

Others treating patients with alcohol problems were found to be giving out paracetamol too often - endangering already damaged livers.

The findings, from inspections of 68 clinics run by the independent sector, found 63 per cent were not providing safe care and treatment.

Nearly three in four were found to have been failing in at least one fundamental standards of care.

The Royal College of Psychiatrists said the findings uncovered “systemic failings” across the sector.

Staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.

Paracetamol was regularly given too frequently to those with liver damage due to their heavy alcohol use.

Staff did not know how to cope with common side-effects of withdrawal - such as seizures.

Others lacked training in basic life support, inspectors found.

The failure to follow guidance about how to prescribe drugs to alleviate the effects of withdrawal was “could reduce the likelihood of successful withdrawal and increase the likelihood of complications and avoidable harm with potentially fatal outcomes” inspectors found.

CQC said every provider now needed to review their practices to ensure safe care was provided.

Dr Paul Lelliott, deputy chief inspector of hospitals said: "Based on our inspections over the last two years, we are deeply concerned about how people undergoing residential-based medical detoxification from alcohol or drugs are being cared for in many independent clinics across the country.”

"While we have found some services that are providing good care and we are beginning to see improvements, all providers need to review their practice so that we can be assured that they are delivering safe and effective care.”

He said detoxification was a “difficult, unpleasant and sometimes, risky experience” which needed staff to be trained in the right skills.

Four of the services are no longer operating following the concerns raised by CQC on its inspections.

In 2015/16, 2,622 people received medical detoxification from a residential rehabilitation service in England – this is around 1 per cent of the 288,843 people in drug and alcohol treatment as a whole. The services are commissioned mainly by local authorities with people also able to pay privately for treatment.

Professor Colin Drummond, Chair of the Addictions Faculty at the Royal College of Psychiatrists, said: "The CQC report on residential drug and alcohol detoxification makes for sobering reading. The Royal College of Psychiatrists is concerned about the scale of the problems with quality and safety. It shows systemic failings in the way these services are provided and that people undergoing detoxification are being exposed to unnecessary risks.

"Detoxification from drugs and alcohol is not a trivial undertaking and carries risks even in well-resourced services with adequately trained clinical staff. These residential services treat the most vulnerable patients, who mostly have complex physical and mental health problems alongside their addictions.”

“Potential risks include severe alcohol withdrawal including epileptic fits and hallucinations, suicide risk, and risk of prescription opiate drug overdose. Therefore it is essential that staff looking after these patients are properly trained, follow national clinical guidelines, and have appropriate 24-hour medical cover. The CQC report shows that in many cases this is not happening."