Intended for healthcare professionals

Head To Head

Should heroin be prescribed to heroin misusers? No

BMJ 2008; 336 doi: (Published 10 January 2008) Cite this as: BMJ 2008;336:71
  1. Neil McKeganey, professor of drug misuse research
  1. 1University of Glasgow, Glasgow G11 6PW
  1. n.mckeganey{at}

    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

    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 …

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