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The primary care treatment of drug users: is shared care really the best approach?

Since the early 1980s in Britain, specialist reports and government policy documents have encouraged the involvement of general practitioners (GPs) in the treatment of problem drug users. More recent guidelines on the clinical management of drug misuse further emphasise a central role for primary care staff, and the principle of 'shared care' is advocated as the mechanism by which this role may be fulfilled. To date, and in spite of these policy initiatives, the involvement of GPs has been described as 'patchy and slow'. This paper examines the historical peculiarities of British drug policy to help understand the challenges of contemporary care. It is proposed that specialist-led models of 'shared care' may militate against GP involvement and alternative approaches to the primary care management of drug misuse are examined. 'Primary care facilitation' is presented as one such alternative and its critical features are elaborated.