Personal Views

GPs and junkies

BMJ 1998; 317 doi: (Published 26 September 1998) Cite this as: BMJ 1998;317:892
  1. Andrew Dicker, general practitioner
  1. London

    The stories which junkies tell about their attempts to get help from primary care present some hazardous options. A few GPs have become expert in managing substance misuse; a few have a go but lack the necessary support; but most NHS GPs refuse to have anything to do with junkies. A small group of doctors see junkies privately for large profits.

    The private system works as follows: the doctor takes on the patient with a substance misuse problem and negotiates a prescription. The doctor takes a fee and the junkie pays for the cost of the drugs. The junkies use a proportion of the supply themselves and sell the rest on the street in order to pay the doctor and the pharmacist. The stories of discriminatory and unethical behaviour among doctors are legion.

    Within their terms of service GPs can refuse to keep on their lists patients whom they do not wish to treat. This is an …

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