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REVIEW 2019 HTM file
Supervised consumption sites: a nuanced assessment of the causal evidence
[Consultation draft subject to amendment and correction.] How high should the evidence bar be set when deciding whether to endorse drug consumption rooms?
In a year when drug-related deaths in the UK had peaked, a pioneering study of drug safety testing was conducted on festival grounds. Its impact on drug-related harm was measured at various levels, including drug-related hospital admissions, behaviours of 230 people who received harm reduction advice, and actions that stakeholders took after receiving information about drugs being mis-sold or contaminated.
Opioid substitution therapy is a safe and effective approach for suppressing illicit opioid use. Helping to guide optimal provision, this review investigates the relative effects of methadone and buprenorphine on the rate of mortality over time.
At issue was whether by successfully referring heroin users to treatment, probation services in England would protect them from fatal overdose and prevent drug-related crime. Yes to one, but not the other, were the answers; in fact, crime went up.
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.
Important implications for overdose prevention policy and practice in Scotland and the UK from this qualitative study which provides the first detailed insights into how people who inject drugs experience administering naloxone rescue kits.
Buprenorphine may be associated with a lower risk of mortality than methadone among people engaged in opioid substitution treatment – but is the pattern of short treatment duration in the UK preventing maximal impact at a population level?
HOT TOPIC 2018 HTM file
Ethics and evidence on naltrexone treatment of offenders
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Opinion is sharply divided on the ethics and effectiveness of pressuring opioid-dependent offenders to take the opiate-blocker naltrexone. Especially sharp is the controversy over long-acting products not approved for medical practice in the UK. Do they constitute an unacceptable infringement of autonomy, or is forcing them on some offenders as caring as holding back someone about to (by choice or not) walk off a cliff?
Added to basic counselling alone, monthly injections of the opioid-blocking drug naltrexone helped prevent relapse among US offenders with a history of opioid dependence recently released from prison or under criminal justice supervision in the community – findings most applicable to those who prefer opioid-free to opioid-maintenance treatments.
From France the first study to randomly allocate patients to start methadone maintenance either in primary care or at a specialist centre found primary care more attractive to patients, and no less effective at reducing street-opioid use and promoting engagement and retention.
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