Understanding drug-using clients' views of substitute prescribing (1999)

In recent years, there has been an increase in drug misuse and an unprecedented expansion in substitute prescribing, particularly of methadone. However, substitute prescribing is a controversial practice, requiring ongoing monitoring and evaluation. This paper focuses on one largely unresearched aspect of the prescribing process: drug misusers' self-reported reasons for, and expectations of, obtaining a prescription. Semi-structured qualitative interviews were conducted with 124 illicit drug users in rural, urban and inner city areas of Scotland and the respondents' comments were analysed inductively using the software package, Winmax. The study found that drug users' reasons and expectations for obtaining substitute drugs were many and varied, but also susceptible to change over time. Nevertheless, many respondents expected to be taking substitute drugs for a significant period, anticipating and desiring sustained maintenance prescribing rather than rapid reduction. Additionally, the interviewees' responses were frequently reactive rather than proactive and this reflected the many negative and constraining factors influencing their lives. It is argued that drug misusers can have a high level of insight into their personal circumstances and aspirations and that their views and experiences are an important resource in the substitute prescribing process. The implications of these conclusions for social work practice are then considered. [Author's abstract]