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In this US treatment study, receiving services matched to need was associated with greater reductions in illegal drug use, supporting calls for services to address not just dependence but also medical, psychological, social, housing, and vocational needs.
For the first time an analysis of relevant studies has assessed the relative contributions of higher doses and flexibility in setting doses to improving retention in opiate substitute prescribing programmes. Both it seems help retain patients in treatment.
Though intended for Baltimore this review will be of great value for administrations everywhere considering heroin
prescribing programmes. It is particularly useful for its accessible style and hands-on portrayal of existing
Brief but thoroughly researched review commends prison methadone programmes as causing no substantial problems while improving the climate in prison, reducing drug use and infection risk behaviours, and improving post-release treatment uptake and recidivism rates.
Canadian study documents what happens when you 'deregulate' methadone prescribing and permit greater patient choice in treatment and treatment goals. Result: room for more patients, less conflict and no decrease in effectiveness.
US studies find that even when slow methadone detoxification is bolstered by psychosocial therapy and aftercare, methadone maintenance does better at prolonging the lives of opiate-dependent patients at relatively little extra cost.
The most comprehensive recent study of serious medical incidents during and after treatment for opioid dependence highlighted the risk of overdose death when patients stop taking opiate-blocking drugs. In comparison, substitute prescribing was safer even after the patient had left treatment.
Are therapeutic communities incompatible with methadone maintenance? Not when staff have been prepared to accept and work with methadone patients and programmes adapted to accommodate them. Then patients stay as long and sustain abstinence from illegal drug use just as well as other residents.
US study shows the value of immediate post-release transfer to an awaiting methadone maintenance slot for formerly heroin dependent prisoners willing to try this treatment but is less clear on the value of actually starting the treatment in prison.
Australian study addressing an issue greatly exercising the UK: do you get greater returns per £ from residential rehabilitation or from substitute prescribing? In terms of reduction in the frequency of heroin use, prescribing was one-and-a-half to three times more cost-effective.
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