‘The British System’: past, present and future

Abstract

The British System is on the move again. As the significance of HIV infection amongst injecting drug users becomes apparent, so it is necessary for drug services to re-axamine their practice, identify new priorities if necessary, and adapt their style of work accordingly. The two reports on AIDS and Drug Misuse from the Advisory Council on the Misuse of Drugs give guidance on the necessary changes required in both specialist and generic services. The potentially beneficial role of prescribing is being re-examined; and ‘harm-reduction’ approaches are being incorporated into the clinical practice of established drug clinics, newer community drug teams and recent syringe exchange schemes. It is argued that there is value in working towards ‘intermediate goals’ other than abstinence, and that attention should be focused on the achievement of certain critical intermediate goals, such as the move from injectible to oral-only drug use. Consideration is also given to the practical and organisational problems which need to be overcome if the British System is to adapt with sufficient force and sufficient speed to the changing circumstances of tomorrow.