From illegal poison to legal medicine: a qualitative research in a heroin-prescription trial in Spain

Drug Alcohol Rev. 2009 Mar;28(2):186-95. doi: 10.1111/j.1465-3362.2008.00015.x.


Introduction and aims: In recent decades, studies have been made of the possible benefits of treatments using heroin, although qualitative methodologies have not usually been employed. In 2004, in Granada (Spain), a clinical experiment was launched: the Experimental Narcotics Prescription Programme in Andalusia (PEPSA). This project attempted to evaluate the effectiveness of intravenous heroin and orally-administered methadone prescription for long-term socially-excluded opiate addicts for whom other treatments have failed. The research described herein is qualitative and has been carried out within the framework of the aforementioned experiment. The objective was to discover the attitudes, opinions and experiences of patients (and relatives) once they had been included in the program and are receiving heroin in a therapeutic environment.

Design and methods: Focused ethnographic procedures were used to establish the study population. During the field work, we carried out in-depth interviews and observations using 21 patients and relatives. Analysis was carried out by a team according to grounded theory.

Results: Our results show how the treatment process and the administering of heroin in a therapeutic context manages to break the habit of consuming heroin obtained illegally, thus changing the significance given to the substance and bringing about improvements in aspects such as the workplace, family relations and physical and mental health.

Discussion and conclusions: The move from 'substance addiction' to chronic 'illness' upon beginning the treatment provides a chance for a population with a long history of rejection and exclusion to become part of society once again.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Drug Administration Schedule
  • Drug Prescriptions
  • Female
  • Heroin / administration & dosage
  • Heroin / therapeutic use*
  • Heroin Dependence / drug therapy*
  • Heroin Dependence / rehabilitation
  • Humans
  • Male
  • Methadone / therapeutic use
  • Narcotics / administration & dosage
  • Narcotics / therapeutic use*
  • Qualitative Research
  • Social Support
  • Spain
  • Substance Abuse, Intravenous / drug therapy*


  • Narcotics
  • Heroin
  • Methadone