Editor—That 45-88% of the participants in the study of van den Brink et al did not respond to the co-prescription of heroin is disappointing.1
As a general practitioner I see daily the interaction between patients' wellbeing and their social circumstances. Poor housing, unemployment, and chronic relationship difficulties are well recognised contributors to the illness behaviour. In the treatment of heroin addicts we need to take a multifaceted approach to their treatment. My anecdotal experience has been that those addicts who are either in employment or who are able to find employment while in treatment fare better than those who remain unemployed.
I long to see the day when we are able to provide a community based drug treatment programme that offers the provision of housing, sheltered employment, drug treatment, and psychological support together. If rehabilitation is our serious aim we need to provide a much more coordinated treatment programme or we will be forever disappointed with the long term results.
Competing interests: None declared.
References
- 1.Van den Brink W, Hendricks VM, Blanken P, Koeter MWJ, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ 2003;327: 310-2. (9 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]