Prescribing to drug misusers in practice--often effective, but rarely straightforward

Many reviews describe the effectiveness of methadone treatment in reducing illicit drug use and associated behaviours among opiate misusers. The strongest evidence includes social outcomes such as reduced debt and crime, and relates overwhelmingly to maintenance rather than detoxification treatment. Drug clinics are often dominated by individuals unable to withdraw fully from methadone, while the "harm reduction" model accepts some ongoing drug use, with attendant risks. Security measures are necessary to avoid abuse of treatments, but these may be undermined by the agenda of "partnerships with patients" in decision-making. Buprenorphine appears both safer and less addictive than methadone, and lofexidine is effective as a non-substitute detoxification method. Naltrexone can clearly reduce relapse rates, provided consumption is assured, while for individuals unable to detoxify or avoid euphoriant opiates, morphine and diamorphine are sometimes used. In non-opiate misuse, clinical studies of a wide range of medications have produced relatively few positive findings.