New approaches to dealing with opioid drug dependence

Abstract

In England there are an estimated 260 000 heroin users.1 Globally, 210 million people use illicit drugs each year, leading to approximately 200 000 deaths.2 Last year the UK government launched a new drug strategy that claimed to offer a fundamentally different approach to dealing with drug dependence, placing the concept of ‘recovery’ at its heart.3 But what is recovery and is it really a new approach to patient care? Also, how may this affect primary care clinicians’ day-to-day management of patients with drug problems? The subtitle to the new drug strategy makes the aim clear: ‘Supporting people to live a drug-free life’. This represents a shift from a harm-reduction approach, where needle exchange programmes and opioid substitution treatment have been seen as key interventions. The new strategy emphasises the importance of going further with ‘the expectation that full recovery is possible and desirable.’3 While this may seem a logical step, there is a danger that the drive to attain and maintain a drug-free life ignores the hierarchy of goals of drug treatment (Box 1),4 where significant benefits, for both individuals and society, can be achieved short of abstinence. The wider recovery movement recognises this and avoids being prescriptive in advocating an abstinence-based approach. The language of the new drug strategy, while not mentioning compulsion …