Advocating for diamorphine: Cosmopolitical care and collective action in the ruins of the ‘old British system’

Dennis, Fay. 2021. Advocating for diamorphine: Cosmopolitical care and collective action in the ruins of the ‘old British system’. Critical Public Health, 31(2), pp. 144-155. ISSN 0958-1596 [Article]

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Abstract or Description

Britain was the first country in the world to prescribe diamorphine (pharmaceutical-grade heroin) to heroin users as a treatment for opioid dependency. Known and admired internationally as the British System, Britain has a somewhat more ambivalent relationship to its own invention. Where patients were once prescribed diamorphine and other injectable opioids on an unsupervised basis, new patients are no longer initiated in this way and those existing ‘old system’ patients are under threat. Carrying out ethnographic research at an advocacy service for people who use drugs, I explore this threat as an onto-epistemological concern and the advocates’ work to sustain these ‘old’ ways of knowing and being with diamorphine as a collective matter of care and action. Accounting for advocacy as a non-objective ‘emboldening’ of the individual to speak, the advocates draw our attention to the inequity of knowledge production and the collective act of speaking in an environment that is increasingly hostile towards these patients. As neoliberal political economies interact with stigmatising forces against people who use drugs, the article highlights the advocate’s work as essential in allowing these patients’ concerns to be heard where a threat to their prescription becomes a threat to their very way of living.

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This research was supported by a Wellcome Trust Research Fellowship in Social Science and Bioethics; Wellcome Trust [209912/Z/17/Z].

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Advocacy, care, cosmopolitics, diamorphine prescribing, heroin dependency

Departments, Centres and Research Units:

Sociology > Centre for Invention and Social Process (CISP) [2016-]


4 June 2020Published Online
14 May 2020Accepted

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Date Deposited:

16 Jun 2020 09:31

Last Modified:

11 Jun 2021 06:07

Peer Reviewed:

Yes, this version has been peer-reviewed.


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