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This US randomised trial in Rhode Island among formerly opiate dependent prisoners found that starting methadone treatment in prison radically improved treatment uptake on release and reduced heroin and cocaine use over the following six months, confirming results from Baltimore.
Largely due to the treatment's health benefits, this review argues that failure to implement effective opioid maintenance programmes in prison represents an important missed opportunity to engage high-risk drug users in treatment, at possibly substantial costs both to individuals and to the community.
A review reporting on the results of six trials from the UK, USA and Australia finds that – at least on their own – interventions such as counselling and peer-educator training have not prevented injecting drug users becoming infected with hepatitis C.
REVIEW 2012 HTM file
Consideration of naloxone
The UK’s official drugs law and policy advisory body recommends that alongside training, the opiate-blocker naloxone be made more widely and easily available to enable drug users and those who work and associate with them to prevent opiate overdose deaths.
The evaluation which led to the Welsh national programme to distribute naloxone to opiate users and their associates to curb rising overdose deaths, one of several UK studies to give momentum to this peer-based strategy.
A major concern about needle exchanges is that after use the injecting equipment they supply will be left unsafely disfiguring public areas, but this US study based on a comparison between San Francisco (has legal exchanges) and Miami (exchanges illegal) strongly suggests the opposite.
Fifteen years of research into Vancouver’s needle and syringe programme leads to the conclusion that such programmes can stop the spread of HIV and do not increase harms. However, they can only be effective if their policies allow sufficient sterile equipment to be distributed to ensure injectors always have fresh supplies.
STUDY 2012 HTM file
Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland
National survey of injectors attending services supplying injecting equipment suggests methadone maintenance plus an abundant supply of needles and syringes help protect Scottish injectors from infection by hepatitis C.
For the first time regular checkups to promote treatment re-entry have been tried with an all-female problem substance user caseload, and one leaving prison rather than community-based treatment. Over the first three months more returned to treatment more promptly. Previous studies suggest this will lead to reduced substance use, crime and HIV infections.
The first study to synthesise the relevant evidence adds weight to the conclusion that methadone programmes protect dependent opiate injectors against HIV infection, and that the evidence in their favour is more convincing than for alternative types of treatments.
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