Using MHF effectively removes withdrawal anxiety triggered by visibly shrinking medication and works well with the patient's consent. Patients who find it very difficult to give up injecting altogether may benefit from a change to injectable preparation for just one or two days a week while remaining on oral drugs the rest of the time. Injection kits should be prescribed with the drugs. There has been a great deal of debate recently about the prescription of amphetamines. The feeling here is that one must be very cautious about this kind of treatment.
Stimulants are much more likely to be destabilising than opiates for simple pharmacological reasons.
The net effect may be an increase in chaotic use rather than the opposite. However, with well motivated patients an amphetamine script may help reduce illicit use and injecting, and establish a useful relationship with workers at the agency. Much of the polemic around this subject has confused the therapeutic gains to the individual patients with the separate issue of public health. Attracting drug users into agency contact at any price is neither beneficial to the user, nor to society. Prescribing at too small a dose is likely to have little effect on the target behaviours.