General practitioners and opiate-abusing patients

General practitioners' involvement with patients who abuse opiates has increased in recent years but little is known about the difficulties they may encounter in working with such patients. This study examined a series of general practitioner consultations with patients who were abusing heroin and describes the problems that arose. Manipulative behaviour, lying about symptoms and a lack of motivation to give up drug use were common among drug abusers; by such behaviour, the patients failed to satisfy the underlying assumptions on which the doctor-patient relationship ordinarily depends. There is a need to evolve alternative approaches for the care of this group of patients which will help general practitioners to establish more effective relationships with them.