Injectable methadone prescribing in the United Kingdom--current practice and future policy guidelines

Unlike other countries, there is a tradition in the UK to prescribe injectable methadone to opiate addicts as treatment for their addition. Along with injectable heroin prescribing, this approach has been labeled as the "British System." It has caused controversy at home and abroad, and provided a hot topic for debate among its advocates and critics since 1926. Over the years, intravenous opiate misuse has increased globally due to diverse social, psychological, and political reasons. The UK has also reflected similar, if not adverse, trends nationally. Following an increase in the number of intravenous opiate misusers, a growing minority of them is being prescribed injectable methadone as treatment. In the absence of comprehensive guidelines or policy from the Home Office and the Department of Health, this practice has serious practical, ethical, and legal implications for the health professionals involved. We propose an injectable methadone prescribing policy, based on our clinical practice, to stimulate relevant research/debate and for possible use in the national or similar international services.