BMJ  2008;336:71 (12 January), doi:10.1136/bmj.39422.503241.AD

Head to head

Should heroin be prescribed to heroin misusers? No

¹ University of Glasgow, Glasgow G11 6PW

doi: 10.1136/bmj.39421.593692.94doi: 10.1136/bmj.39434.460694.AD

Some heroin addicts are very difficult to treat. Jürgen Rehm and Benedikt Fischer believe that maintenance with heroin is the way forward for this group, but Neil McKeganey argues that it is treating the effects of misuse not the addiction

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

Prescribing heroin to heroin addicts is a strategy beloved by top police officers¹ and successive home secretaries.² It is a strategy, though, borne of utter frustration at our seeming inability to tackle an escalating drug problem. If you cannot stop addicts committing crimes to fund their drug habit then, so the argument goes, the next best thing is to provide them with the drugs that are the reason they are committing the crimes in the first place. The logic may seem faultless, but at the back of your mind is the nagging question, "Is it treatment or is it social problem prescribing?"

The evidence in relation to heroin prescribing is far from conclusive. On the positive side Nordt and Stohler have suggested that heroin prescribing led to a large reduction in incidence of heroin addiction in Switzerland, although the authors also point out that such prescribing may have reduced individual’s . . . [Full text of this article]

Risks of prescribing

What are we treating?

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• Weeks, R. (2008). Prejudice based medicine?. BMJ 336: 173-173 [Full text]  

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