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The UK has a long history of prescribing heroin for the treatment of heroin dependence. What has research from six countries concluded about this intensive intervention intended for patients who would otherwise be considered ‘unresponsive’ to treatment?
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell B3: Practitioners; Medical treatment
Seminal and key research and reviews on the influence of the practitioner in the medical treatment of drug dependence. Investigates the how clinician-patient relationships might be affected by enforcing clinic rules and the potential importance of doctors forming a “whole person’ relationship with patients.
DOCUMENT 2017 HTM file
Drug misuse and dependence: UK guidelines on clinical management
Last published in 2007, there is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offers detailed guidance on the range of problems, settings and patients clinicians encounter, substantially informing judgements of what constitutes good medical practice.
This German study shows that heroin maintenance treatment can contribute to greater reductions in drug and property offences than methadone maintenance.
HOT TOPIC 2015 HTM file
Prescribing opiate-type drugs to opiate addicts: good sense or nonsense?
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. For decades deeply felt and at times intemperate debate has surrounded a treatment which achieves unparalleled success by going with the grain of addiction, prescribing the same type of drug which opiate-dependent patients used illegally – a substitution castigated as surrender or hailed as an enlightened lifesaver.
REVIEW 2013 HTM file
Maintenance agonist treatments for opiate dependent pregnant women
Is it better to prescribe pregnant opioid-dependent women methadone, buprenorphine or oral morphine? Just four randomised trials have addressed this issue and their findings are inconclusive, suggesting greater holding power for methadone but less severe neonatal withdrawal with buprenorphine.
Unless there is a compelling medical or social contraindication, results of extended treatment in the Dutch heroin prescribing trials suggest treatment should be continued as long as possible for heroin-addicted patients who have been failed by methadone but benefit from being prescribed heroin.
STUDY 2014 HTM file
Drugs: international comparators
After seeing how drug policy worked overseas, UK government ministers and officials returned saying, “there is no apparent correlation between the ‘toughness’ of a country’s approach and the prevalence of adult drug use”, and that “better health outcomes for drug users cannot be shown to be a direct result of the enforcement approach”.
Practitioner-friendly review from the British Association for Psychopharmacology on drug-based treatments for substance dependence offer authoritative, evidence-based guidance to prescribers and others; they also demonstrate the limitations of trying to cure over-use of drugs with drugs.
Prescribing oral methadone to heroin addicts divides opinions, but prescribing injectable heroin elevates the controversy to another level. Fortunately we now have six randomised clinical trials involving over 1500 patients to ground us in the evidence – and this European Union review to pull it all together.
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