Survey of doctors prescribing diamorphine (heroin) to opiate‐dependent drug users in the United Kingdom

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Abstract
Aim To determine the scale and practice of diamorphine (heroin) prescribing for opiate dependence in the United Kingdom in 2000. Design Postal survey. Setting England, Scotland and Wales. Participants One hundred and eleven of the 164 doctors in the United Kingdom on the Home Office record as holding a licence to prescribe diamorphine (response rate 68%), and 59 of the 108 doctors in the United Kingdom eligible to hold a licence (working in drug clinics), but not doing so (response rate 54%). Measurements The characteristics of doctors (a) holding a licence and (b) currently prescribing; the number of opiate users receiving a prescription; current treatment delivery, clinical criteria for patient eligibility; and reasons for prescribing or not prescribing diamorphine. Findings Seventy of the 111 doctors actually held a licence. While the majority were consultant psychiatrists, five were general practitioners. Forty‐six were currently prescribing to 448 patients. The majority of prescribers reported that they had not initiated a prescription for diamorphine but had inherited patients already receiving such a prescription. Most of those who prescribed considered that in selected cases it could produce clinical and social improvement. There were great variations in clinical criteria for patient eligibility, prescribing practice, daily dose prescribed (range 5–1500 mg) and the daily dose‐equivalent of 100 mg methadone (range 50–900 mg). Many respondents cited lack of appropriate resources as a reason for not prescribing to more patients. Reasons for non‐prescribing varied from lack of resources to little evidence of its effectiveness. Conclusions The prescribing of diamorphine to opiate dependent drug users remains rare in the United Kingdom. Not all eligible doctors seek a licence to prescribe, and not all those with licences actually prescribe it. There is no clear consensus on who should be treated with diamorphine and in what way.