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How confident can we be that take-home naloxone programmes are effective without the ‘gold standard’ randomised trial? Judged against nine criteria for establishing the presumption of causality, evidence that the provision of naloxone reduces overdose-related deaths among opioid users.
HOT TOPIC 2016 HTM file
Harm reduction: what’s it for?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Opposing agendas have led to a shifting balance between seeing harm-reduction as acceptable only in the service of the greater good of reducing or eliminating drug use, versus seeing it as the overriding objective, one which should never be sacrificed to an anti-drugs agenda.
After adjusting for other influences, heroin users diagnosed as dependent at a psychiatric centre in Taiwan who started opioid substitution treatment lived nearly eight years longer than those who did not enter treatment. However, the treated group were more likely to commit suicide, usually associated with a history of depression.
From the USA’s professional society for clinicians and allied professionals in the field of addiction medicine, comprehensive recommendations on how doctors can use medications to treat addiction to heroin and other opioids.
Using data pooled from studies in three countries, researchers examined the impact of hepatitis C testing and counselling – and of testing positive versus negative – on whether people who inject drugs become more or less likely to risk infection.
Primary care methadone patients in Ireland were nearly four times more likely to die during periods out of treatment; the first few weeks after leaving were the peak risk period. The study’s support for unbroken, long-term treatment runs counter to recent UK government policy.
Failure to find effects concentrated in the first two weeks after release persuaded analysts that widespread methadone prescribing in Scottish prisons from 2002 did not reduce the rate of drug-related deaths after release. But over 12 weeks the rate did fall substantially, and methadone treatment may have helped.
In the UK context, this study’s findings imply that to prevent new cases it is best to focus expensive new treatments for hepatitis C infection on injectors who infrequently share their injecting equipment – patients most likely to be found and recruited via needle exchanges and addiction treatment services.
This intervention based on housing first led to significantly greater reductions in drinking problems after 14 months, but not in problems with other substances.
Injectors at risk of infection due to sharing equipment responded best to brief risk-reduction counselling based on motivational rather than educational principles, offering a way to augment the benefits of harm reduction services.
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