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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 18; 335(7615): 317.
PMCID: PMC1949467
Payment for Treatment Adherence

Drug misusers are likely to abuse the system

Richard J Stevenson, forensic physician

I am a forensic physician working in the east end of Glasgow, and I write with reference to the debate by Burns and Shaw.1 2 A high percentage of detainees are on opiate substitution programmes. From my own personal observations, nearly all are using “top-up” heroin.

Additionally, alcohol consumption while receiving methadone treatment is high. It is obvious that a £2 shopping voucher could easily be diverted into paying for two litres of cider to fund a dual addiction.

I also find it ridiculous in a cash strapped NHS service, where we are unable to fund life saving or life extending medications, we are able to pay addicts to “comply” with a treatment that offers no treatment benefit other than to “reduce harm.”


Competing interests: None declared.


1. Burns T. Is it acceptable for people to be paid to adhere to medication? Yes. BMJ 2007;335:232 (4 August.) [PMC free article] [PubMed]
2. Shaw J. Is it acceptable for people to be paid to adhere to medication? No. BMJ 2007;335:233 (4 August.) [PMC free article] [PubMed]

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