Strict limits on how long drug addicts are allowed to stay on heroin substitute methadone have been proposed by the government body responsible for treatment strategy, in what will be seen as a watershed in UK drugs policy.
The National Treatment Agency for Substance Misuse (NTA) is describing the move as a rebalancing of the system in favour of doing more to get addicts clean.
But cynics will regard the shift by the NTA, which has faced criticism and calls for it to be scrapped, as a late attempt to save itself before the coalition review of arm's-length government bodies.
Martin Barnes, the chief executive of the DrugScope charity, which represents 700 local drugs agencies, said: "A goal of avoiding open-ended prescribing through improved practice is not the same as, and should not be confused with, the setting of time limits."
An estimated 330,000 people in England and Wales are addicted to heroin, crack cocaine or both. More than 200,000 are in contact with treatment agencies, but most are "maintained" on methadone or other synthetic opiates, at a cost of £300m a year, rather than pushed towards abstaining from all drugs, whether prescribed or illegal. Strict time limits on methadone treatment would require a big expansion of residential care for addicts.
In a report last week the influential Centre for Social Justice, set up by former Conservative party leader Iain Duncan Smith, called for the NTA to be scrapped and replaced by an "addiction recovery board" covering drugs and alcohol misuse. The report repeated claims that only 4% of drug addicts are emerging clean from treatment.
The NTA, which is responsible for England, disputes this figure, saying that the number of people "successfully completing treatment free of dependency" rose to 25,000 in 2008-09, about 12% of those who were in "effective" treatment.
However, the agency has accepted that it needs to revise its approach in view of the change of government. In draft changes to its business plan, approved by the NTA board but not yet signed off by ministers, it states: "We intend to take forward the government's ambition for a rapid transformation of the treatment system to promote sustained recovery and get more people off illegal drugs for good."
The aim, the draft says, is to rebalance the system and "ensure successful completion and rehabilitation is an achievable aspiration for the majority in treatment".
The idea of time limits is drawn from new Department of Health clinical guidance for opiate prescription in prisons. The guidance requires that offenders serving sentences of six months or more should have any prescription reviewed at least every three months. The prison guidance states: "If there is some exceptional reason why abstinence cannot be considered, then the reason must be clearly documented on the clinical record at each three-month review."
In the draft revision of its business plan, the NTA says: "No one should be 'parked' indefinitely on methadone or similar opiate substitutes without the opportunity to get off drugs. New clinical guidance has introduced strict time limits to end the practice of open-ended substitute prescribing in prisons. This principle will be extended into community settings.
"New clinical protocols will focus practitioners and clients on abstinence as the desired outcome of treatment, and time limits in prescribing will prevent unplanned drift into long-term maintenance."
The NTA declined to comment on its proposals. But word of its policy shift is prompting excited debate in the £1.2bn drugs treatment sector. The methadone issue became totemic for critics of the Labour government's social and criminal justice policies, and was raised repeatedly by David Cameron during the general election campaign.
Karen Biggs, the chief executive of Phoenix Futures, a leading treatment provider, welcomed the move towards a "better balance" in the treatment system. "There are excellent examples across the country of recovery-orientated treatment systems that help people move from the most chronic addictions to a life of recovery," Biggs said. "A balanced treatment system which is ambitious for the individuals and communities with which it works will contribute to the wider social policy objectives of the coalition government."