Prescription of substitution treatments of Belgian GPs and public policies
In Belgium, authorities alternate between repressive and sanitary measures to drug use. Those two tendencies coexist and form a complex landscape. The recent publication of a royal decree regulating the prescription of substitution treatments (2004, amended in 2006) had a direct impact on the practices of general practitioners (GP’s), whether or not those accept the follow-up of drug users. How do GP’s experience this legal inference into medical practice, after more than ten years of practice within a relative prescription tolerance? What are the (unexpected) consequences? Based on narratives of GP’s, observations and group analyses, this paper proposes to examine the impact of the introduction of a new legislation on the practices of GP’s. Those GP’s who used to refuse drug users see in the introduction of this new rule an additional risk, and decide further not to involve. Those who took a small number of drug users patients try to diminish or to stop this activity. Those most involved GP’s overreach the legal framework and see themselves threatened of law suits if they don’t adjust. This new legislation might have consequences for the access to GP care for drug users, and therefore rises questions around specialization in general practice.