Treat patients, not communities

doi:10.1136/bmj.39465.512373.3A

BMJ 2008;336:173 (26 January), doi:10.1136/bmj.39465.512373.3A

Letters

Heroin prescription to misusers

Treat patients, not communities

The first 150 words of the full text of this article appear below.

Prescribing heroin to those who use it other than for analgesiasimply redefines "offenders" as "patients."¹ ² The term "misuser"implies a lack of social acceptance. Prescription removes the"mis" but, in so doing, allows the "user" to re-enter the socialgroup and solves crime at a stroke by legitimising previouslycriminal behaviour.

People with drug problems need services that take them througha continuum of making safe (reducing immediate risk of overdose),harm reduction (reducing later risk of bloodborne virus), dosestabilisation, detoxification, and relapse prevention. Prescribingof heroin probably affects those needing services towards thebeginning of the continuum.

Current NHS services tend to concentrate on harm reduction anddose stabilisation, with the private sector offering detoxificationand the criminal justice sector (often police custody sergeants)providing making safe services.

Despite its importance as the final part of a potentially curativeprocess, effective relapse prevention—such as the useof . . . [Full text of this article]

Andrew J Ashworth, general practitioner

¹ Davidsons Mains Medical Centre, Edinburgh EH4 5BP

andrew.ashworth@lothian.scot.nhs.uk