In the past decade, primary care services have expanded in the clinical area of substance misuse. With tiered systems of drug treatment delivery, patients with complex needs are usually treated by specialist services, with primary care seeing the less complex patients. This article argues that this approach needs to be re-visited and updated, as primary care can accommodate many patients who are classed as complex. The article illustrates this by examining patients in primary care who are on high doses of methadone and argues that primary care could be expanded further to address the needs of these patients.