“The past is a foreign country: they do things differently there.” The famous line from L P Hartley’s The Go-Between seems to sum up the medical prescribing of heroin to addicts. British medicine has a history of prescribing heroin, and the practice is now also largely accepted in Switzerland and the Netherlands. But use of the British system, as it was known abroad, in the United Kingdom has declined in favour of methadone maintenance—although not vanished completely.

It was 1926 when a government committee chaired by Humphry Rolleston, president of the Royal College of Physicians, advised it was legitimate medical practice to supply heroin to addicts for their maintenance. Only later was the practice restricted to doctors licensed by the Home Office. Past UK examples include the drug dependency clinic of London’s University College Hospital, which prescribed injectable heroin during the 1970s.1 Later, a team led by psychiatrist John Marks offered heroin on prescription in Widnes, Merseyside, in an attempt to restrict the spread of HIV.

However, by 1992 researchers estimated there were little more than 100 addicts prescribed heroin in the UK, while 17 000 were prescribed oral methadone.2 Today the number of addicts in the UK regularly prescribed heroin is around 300, although the practice is enjoying a revival.3 A trial of supervised injecting, the randomised injecting opioid treatment trial (RIOTT), among 150 addicts at clinics in Brighton, London, and Darlington is set to run until 2008.

Similar relatively small scale trials of heroin assisted treatment have taken place in Canada, Spain, and Germany, where a multicentre trial with …