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.