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Survey responses from clinicians prescribing methadone at Scottish addiction treatment clinics show how the requirement that patients be observed taking the medication involves striking a balance between safety, individualising treatment, and attracting and retaining patients.
REVIEW 2011 HTM file
Heroin maintenance for chronic heroin-dependent individuals
Update of the first authoritative review to combine results from all trials to date of long-term heroin prescribing for the management of heroin addiction finds important advantages for seemingly intractable patients previously failed by methadone, including reduced illegal drug use.
British guidelines suggest electrocardiogram screening of methadone patients at heightened risk of a form of possibly methadone-aggravated cardiac disorder which can result in sudden death. But a London clinic found this would still mean testing most patients, with huge resource implications yet uncertain benefits.
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
Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial
Controversial and expensive it might be, but in the first British randomised trial, a continental-style heroin prescribing programme featuring on-site supervised consumption suppressed illegal heroin use much more effectively than oral methadone.
This British study concluded that it takes extended opiate substitute prescribing to realise the treatment's life-saving potential. The implication is that the current push to get people off methadone sooner could cost lives.
NOTES 2010 PDF file 239Kb
Preventing unauthorised use of medications prescribed for the treatment of opiate addiction
Detailed and fully referenced notes on preventing the diversion of maintenance medications like methadone on to the illicit market, with an emphasis on the pros and cons of supervised consumption.
Compared to methadone, buprenorphine is more often chosen in a make-or-break attempt to divorce oneself from illicit opiates found the first large-scale study to compare the drugs in real-life conditions at a British opiate addiction maintenance treatment programme.
STUDY 2010 HTM file
The National Drug Related Deaths Database (Scotland) report 2009
New database offering in-depth information on drug deaths in Scotland reveals that 60% of cases had been in contact with drug treatment services, nearly 40% in the past six months, suggesting that there had been chances to intervene which for these patients had been insufficient to avoid death.
On several measures, the few drug dependent patients who accessed aftercare after treatment in Scotland in the early 2000s did better than the majority who chose to or were left to fend on their own – but could this be attributed to the aftercare, or would they have done well anyway?
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