ABSTRACT
Practitioners visiting the UK from almost any other country in the world react to the UK approach to methadone treatment with a mixture of bemused critique, incredulity and a little envy. The curiosity is that the so-called British System, the origins of which are described in many chapters in this book, allows doctors an enormous amount of discretion in the way that they prescribe substitute drugs, usually methadone, and whether or not they associate their prescribing with some form of psycho-social therapy. Not surprisingly there is huge variation in the management of substitute prescribing and the UK style of working is often quite different to that reported in research papers from other countries. The Department of Health Drug Misuse and Dependence-Guidelines on Clinical Management (1999) goes a long way towards requiring a more regulated approach while at the same time preserving legitimate clinical freedoms. Just as most people in the general population have very definite opinions about drug use and drug users, so too do prescribers and the counsellors or therapists with whom they work. The visitor to the UK is likely to detect an absence of consensus on the purpose of methadone prescribing, or in other words treatment outcome goals, and it is unsurprising, therefore, that controversy and misinformation confuse the way that methadone programmes are defined and managed.
