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This debate is featured in the BMJ Jan 12 2008, you may like to give it a read. Notwithstanding the considerable cost, and the complexities of supervised injecting and diversion, the experience from studies in Switzerland and Holland have revealed a range of benefits to justify a limited place in our already limited range of treatment options.
Professor Neil McKeganey, never one to shirk controversy in the addiction treatment policy arena, gave his characteristically forthright view that we should not be contemplating this option: “If you can not stop addicts committing crimes to fund their drug habits, then, so the argument goes, the next best thing is to provide them with the drugs thatt are the reason they are committing crimes in the first place. The logic may seem faultless, but at the back of your mind is the nagging question – is this treatment, or is it social problem prescribing?”
My own view is that it is probably both, and in the spirit of harm reduction, I would defend a limited place for diamorphine prescribing, albeit not by me. But my “nagging doubt” is that this is a further step down the road of the medicalisation of drug dependency – a further tacit acquiescence to addiction being some sort of disease that actually reinforces the misguided belief that drugs are needed - rather than their use being a symptom of a more fundamental malaise.
But give it a read – it is thought provoking.
