Heroin misuse and family medicine

Drug users are a heterogeneous group in terms of social class and background, personality, and patterns of drug use. They are often stereotyped by both the public and the health services and this can lead to obstruction of a successful doctor-patient relationship. The real problem lies not so much in detoxification but in the prevention of relapses and the maintenance of the patient in a drug-free condition. There has recently been a shift in emphasis away from drug treatment centres and hospital based treatment towards community care and family medicine. The role of the family practitioner is largely unexplored yet, rather than inspiring research, the increased contact between general practitioners and drug users has caused concern. This review concentrates on two related areas of study important for family practitioners in the management of drug misuse: the role of drug misuse in family membership and in parenthood. Families have been shown to play a role in the aetiology of drug abuse, but more important is their role in the maintenance of an individual's drug dependence. The family doctor is in an ideal position to recruit the family into the drug user's treatment. Although far fewer 'addicts' come to serious harm than is commonly believed, the risks extend also to the children born of narcotic dependent mothers. Family doctors, obstetricians and paediatricians must be aware of the particular problems for mother and child.