Drug Addiction

Drug Addiction in UK

Drug Addiction in UK

Drug addiction level UK relative to other European countries

Drug addiction is a big problem in UK and other European countries. Looking back on the development of the treatment of opiate addiction in the UK over the last century, there are a number of striking aspects of the British approach that have fascinated and perplexed commentators at home and from abroad. It is these distinctive features of this core response which have been dubbed the "British System" (Strang & Gossop, 2005).

Outside observers of the British approach are often particularly interested in prescribing for opiate addicts. In the UK, any medical practitioner can prescribe (and has always been allowed to prescribe) the opiate substitute methadone or virtually any other drug. Three specific drugs are more restricted - cocaine, heroin, and dipipanone - and only doctors with special licenses can prescribe them in the context of addiction treatment. In practice, such licenses are only granted to doctors who work in National Health Service (NHS) drug clinics, and this authority for prescribing is used only rarely. Guidelines on prescribing have attempted to establish recommended practice, but there is, in reality, wide variation in practice. For example, daily doses of methadone may vary from 5 mgs to an extreme of more than 1000 mgs daily. There is also variation in the form of methadone prescribed - oral mixture, tablets, and injectable ampoules (Strang, Sheridan, & Barber, 1996) - in a way not seen in other countries. Additionally there is a marked contrast between prescribing habits of NHS practitioners and prescribers in the private sector (Strang & Sheridan, 2001).

Another striking feature of the British approach is that it allows doctors, in their role as prescribers, great autonomy. Thus it was only in 1984 that the first prescribing guidelines, The Guidelines of Good Clinical Practice, were published by the Department of Health (Medical Working Group on Drug Dependence, 1984). These were most recently revised in 1999 - Drug Misuse and Dependence: Guidelines on Clinical Management - commonly termed the "Orange Guidelines" due to the color of the publication's cover (UK Departments of Health, 1999). This more comprehensive document targets general practitioners and emphasizes the importance of good assessment, shared-care of patients by general practitioners and specialist services, supervised ingestion (where available), and training. However, these guidelines have no defined legal position, are not themselves regulations, and the prescribing doctor remains largely unfettered.

So how could the absence of a central regulating system have been accepted for so long? This paper provides a brief account of the circumstances that gave birth to and sustained the British approach and how this British system has evolved through periods of stability and points of crisis. The latter part of the paper focuses on new challenges - including the hepatitis C problem and the current state of drug treatment - and concludes with an appraisal of the options with regard to steering the British System in today's increasingly international ...