HAT Wars: The Political History of Heroin-Assisted Treatment

Abstract

This chapter examines the historical development of heroin-assisted treatment from the early twentieth century to the present day. It sketches the philosophical underpinnings of those controversies surrounding the treatment, and the ways in which they have shaped the political and related drug-control environments in which debates over heroin-assisted treatment, and maintenance prescribing more broadly, have taken place. Within this rhetorical context, it argues that most of the notoriety of heroin and the harms with which it is associated stem, in fact, from the policies and controls about the drug, and contend that HAT mixes progressive intentions and methods with elements taken over from the repressive modalities of prohibitive drug control, rendering it a conflicted treatment that remains problematic for people who use heroin.

Keywords: British system of prescribing heroin, Diamorphine, Drug policy, Heroin-Assisted-Treatment, History of drugs, International drug control, Maintenance therapies, Pharmacological determinism, Social understanding, Swiss development of HAT, US influence on drug policy.