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DOCUMENT 2013 HTM file
Can we dispense with counselling, therapy, treatment as we know it, and just punish or deprive patients of rewards when they use substances in undesired ways, and reward them when they behave as we/they would wish? British services are trialling an approach about which many clinicians express major ethical concerns – contingency management.
DOCUMENT 2013 HTM file
Community loses from failure to offer maintenance prescribing in prisons
An international team of experts has argued 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 to the individuals and to the community. Is Britain too losing out, and how does the future look?
Introduced in Scotland and England in the mid-late 1990s to prevent overdose, did supervised consumption of methadone really make methadone maintenance safer? After accounting for increased prescribing, this analysis concludes that it did curb methadone-related deaths.
Slow-release capsules of morphine – the closest drug to heroin – might offer acceptable and effective treatment to addicts who cannot settle on methadone. In England a dozen also being prescribed heroin switched their supplementary methadone to morphine, generally experiencing the benefits they expected and cutting their average dose of heroin.
REVIEW 2012 HTM file
Drug policy and the public good: evidence for effective interventions
Review of relevant research by an international team of leading researchers offers policymakers guidance on the interventions most likely on the evidence to achieve national policy aims in respect of illegal drug use.
What happens when opiate-addicted patients are suddenly no longer required to take their methadone under supervision but can take it away from the pharmacy? In Scotland this was tried in the first UK randomised trial; patients stayed longer in treatment and there was no dramatic escalation in heroin use.
Among the messages of this simulation model for the UK and other countries is the resilience of hepatitis C in the face of considerable investment in methadone and needle exchange services, that these have nevertheless helped and need to be maintained and if possible expanded, but also that further measures are required to substantially curtail the virus.
Together studies recently conducted across the UK suggest that consistent participation in methadone maintenance treatment plus adequate access to fresh injecting equipment has prevented many hepatitis C infections, supporting calls for needle exchange to be expanded and methadone treatment sustained.
STUDY 2010 HTM file
A survey of community drug team prescribing policies and client views
Contrary to national guidelines, in the mid-2000s in England and Wales, prescribed doses of the heroin substitute methadone were generally low, and often even new patients were not required to take it under supervision at the pharmacy. Patients in Essex also generally favoured low doses and opposed supervised consumption.
DOCUMENT 2012 HTM file
Has methadone been rehabilitated?
Arousing visceral opposition and passionate defence, prescribing opiate-type drugs for as long as needed has for decades been the mainstay of heroin addiction treatment in Britain. With the weight of government behind them, that position was challenged by ‘recovery’ advocates; in 2012 an expert report sought to reconcile the competing perspectives.
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