The history of opiate treatment in the United Kingdom (UK) since the early 1980s isa rich source of learning about the benefits and pitfalls of drug treatment policy. We presentfive possible lessons to be learnt about how factors outside the clinic, including government,charities and researchers can influence treatment and outcomes. First, do not let a crisis go towaste. The philosophical shift from abstinence to harm reduction in the 1980s, in response toan HIVoutbreak in injecting users, facilitated expansion in addiction services and made a harmreduction approach more acceptable. Second, studies of drug-related deaths can lead toadvances in care. By elucidating the pattern of mortality, and designing interventions toaddress the causes, researchers have improved patient safety in certain contexts, thoughsignificant investment in Scotland has not arrested rising mortality. Third, collection oflongitudinal data and its use to inform clinical guidelines, as pursued from the mid-1990s,can form an enduring evidence base and shape policy, sometimes in unintended ways. Fourth,beware of the presentation of harm reduction and recovery as in conflict. At the least, thisreduces patient choice, and at worst, it has caused some services to be redesigned in a mannerthat jeopardises patient safety. Fifth, the relationship between the third and state sectors must