Guidelines on the clinical management of drug misuse were first issued by the Department of Health in 1991. The latest version, issued last month,1 has been long awaited and has already sparked controversy. The new guidelines focus more on the role of the generalist than on that of the specialist in drug misuse, so they are particularly relevant to general practitioners.

The differences between the new and the old guidelines reflect changes over the decade both in our knowledge of drug misuse and in service delivery. Firstly, the new guidelines emphasise the developing evidence base, particularly the strong evidence for the effectiveness of methadone maintenance treatment.2 Secondly, they recognise the importance of the structure of service delivery and the key role of shared care within this. The new guidelines place responsibilities not just on doctors but also on commissioning bodies to deliver a service and to support doctors. Thirdly, …