Abstract
Heroin users are prescribed methadone on a long term basis in an attempt to enable them to give up street drug use and develop a more positive lifestyle. Studies (Ward et al, 1994) have shown that such prescribing reduces street drug use and criminal behaviour. However little evidence is available concerning the impact of maintenance prescribing from the perspective of the heroin users themselves. This study uses a qualitative approach to explore the meaning of maintenance prescribing to a group of heroin users. This represents a different way of understanding the value of an intervention and as such is complementary to the more usual quantitative studies. Opiate using clients of a Drug Service were interviewed in depth concerning their perceptions of their former drug use and their lives since having a maintenance prescription. The interviews were coded and critically analysed using the techniques of Miles and Huberman (1994). Three common strands emerged from these interviews: the drug users career into a chaotic lifestyle dominated by the need for heroin; the consistent evidence of low self esteem throughout the lives of these respondents and finally an underlying sense of self-destruction which also permeates their lives. Without exception the maintenance prescription was regarded as crucial to their efforts to rebuild their lives. Many also discussed the value of contact with the Drug team as a vital element in their attempts to stop opiate use. This research suggests that although the provision of an opiate substitute attracts and retains drug users into the service the addition of a psychological therapeutic input could enhance the effectiveness of treatment. In particular, therapy should address self esteem, self harm, problem solving and coping skills. For some, specific interventions related to aggression and childhood abuse would be indicated.