Understanding drug-using clients' views of substitute prescribing

In recent years, there has been an increase in drug misuse and an unprecede nted expansion in substitute prescribing, particularly of methadone. Howeve r, substitute prescribing is a controversial practice, requiring ongoing mo nitoring and evaluation. This paper focuses on one largely unresearched asp ect of the prescribing process: drug misusers' self-reported reasons for, a nd expectations of, obtaining a prescription. Semi-structured qualitative i nterviews were conducted with 124 illicit drug users in rural, urban and in ner city areas of Scotland and the respondents' comments were analysed indu ctively using the software package, Winmax, The study found that drug users ' reasons and expectations for obtaining substitute drugs were many and var ied, but also susceptible to change over time. Nevertheless, many responden ts expected to be taking substitute drugs for a significant period, anticip ating and desiring sustained maintenance prescribing rather than rapid redu ction. Additionally, the interviewees' responses were frequently reactive r ather 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 an d that their views and experiences are an important resource in the substit ute prescribing process. The implications of these conclusions for social w ork practice are then considered.