Intended for healthcare professionals

Rapid response to:

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

Rapid Response:

Solutions to living without addiction to illicit drugs

I have worked in a fulltime position for several years as a medical
officer in the Glasgow Drug Problem Service with a case load of 250
patients and now partime as a "GPwSI" looking after approx 60 patients who
are homeless and addicted to opiates, spanning the last 7 years of my
professional life.
I prescibe methadone and suboxone where clinically indicated and prescribe
as necessary for other general medical problems and refer on when

Substitute prescibing in my opinion should be used as a way of
gaining stability to allow the patient and everyone in their
rehabilitation to work out a plan for living without drug dependency.
These are some of my ideas:

The people I look after need solutions for living:

They need homes in decent areas (somewhere we would be happy to

They need work and training into a job they want to do and one which
offers a living wage.

They need support to make better choices , they have to learn the skills
we take for granted ie "actions we take have repurcussions"

We have to instil hope, where often there is despair and regret.

We have to help them rebuild lives which have been torn apart with child
abuse , domestic violence, loss of their children to adoption. I could go

In my experience people can leave drug dependency , this includes
dependency on prescribed methadone or suboxone only when living a life
without drugs is better than life with drugs and this happens
unfortunately on a vary rare occasion.

Competing interests:
None declared

Competing interests: No competing interests

14 January 2008
Dreena Kelly
GPwSI Addictions
Health and Homeless Team Blantyre G72 OBF