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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.
Can monthly injections of extended-release naltrexone be considered on a par with the standard daily opioid substitute in Norway for people wanting to maintain abstinence from heroin?
Trials challenge the need for the widely accepted policy of making opioid-dependent patients take their methadone or other opioid substitutes at the clinic or pharmacy, but ‘no difference’ findings may be due to the limitations of the research.
STUDY 2014 HTM file
Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial
A randomised trial conducted in England found that the (at the time) recommended three months of supervised consumption of prescribed opioid substitutes like methadone conferred no significant advantages over supervising only for up to the first four weeks of treatment, but the findings applied only to the minority of patients for whom random allocation was thought feasible and safe.
MATRIX CELL 2017 HTM file
Drug Treatment Matrix cell C2: Management/supervision; Generic and cross-cutting issues
Key studies on the role of management and supervision across psychosocial and medical treatments of problem drug use. Highlights that “Manners Matter”, asks, “Is there anything more instructive than being the patient?”, explores the role of patient choice and preferences in treatment planning, and queries the ubiquitous stages of change model as a basis for determining the treatment offer.
STUDY 2017 HTM file
Impact of financial incentives on alcohol consumption recording in primary health care among adults with schizophrenia and other psychoses: a cross-sectional and retrospective cohort study
UK study of how Quality and Outcomes Framework incentives for primary care boosted alcohol screening among patients with severe mental illness shows what could have happened had the incentives been extended across the entire primary care caseload.
Coinciding with a ‘refresh’ of Scotland’s alcohol strategy, evidence that financial incentives in primary care can affect delivery of brief alcohol interventions.
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.
STUDY 2015 HTM file
Changing patterns of substance misuse in adult prisons and service responses
Inspection findings on individual prisons were supplemented by fieldwork in eight prisons in 2014 to generate an overall picture of drug use and responses to it in prisons and England and Wales. In the face of rapidly changing and varied drug use patterns, policy and operational responses were seen as insufficiently flexible and dynamic, though treatment had dramatically improved.
HOT TOPIC 2017 HTM file
Overdose deaths in the UK: crisis and response
One of our selection of hot topics – important issues which sometimes generate heated debate. Why did the fall in UK drug overdose deaths in 2009 to 2012 so decisively reverse in the following years? A life-threatening turn away from harm reduction, or simply an ageing population of heroin users?
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