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Practice-oriented review of what we know about the diversion (to other people) and misuse (mainly by injecting it) of buprenorphine used in the treatment of opiate dependence, featuring extended, practical guidance on how to identify and respond to these life-threatening behaviours as a therapeutic challenge rather than a disciplinary issue.
‘Do just the minimum’ seems the message of the emergency department arm of the largest alcohol screening and brief intervention study yet conducted in Britain; the proportion of risky drinkers fell no less after a brief warning than after more sophisticated and longer interventions.
US trauma centres dealing with serious and often alcohol-related injuries ought to offer an environment conducive to brief alcohol interventions, but this first multi-site trial found motivational counselling more effective than minimal advice only when combined with a follow-up ‘booster’ phone call.
STUDY 2014 HTM file
The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)
A major study conducted in London did not find clinically important reductions in drinking among excessive drinkers offered a brief intervention while attending sexual health clinics, nor did brief intervention seem a cost-effective use of health service resources.
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.
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.
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.
An expert committee responds to the Scottish government’s concerns over the role of methadone prescribing in helping patients along the Road to Recovery signposted in the national strategy. On the ground, that road was often barely constructed but methadone was not the problem, rather the failure to optimise programmes for recovery.
From Norway, strong evidence that being in a methadone or buprenorphine maintenance programme protects heroin-dependent patients from drug-related ill-health including life-threatening overdoses and infections, even if the treatment has not completely subdued illegal drug use.
From Brazilian primary care clinics a rare confirmation that a positive organisational climate featuring commitment to staff professional development and good links with the local community is associated with overcoming barriers to widely implementing screening and brief intervention programmes.
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