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In 2011 Scotland became the first country to fund a national policy of distributing the opiate-blocker naloxone to prevent deaths involving opiate-type drugs. According to this evaluation it did prevent deaths where the effect was most likely to be seen – in the weeks after release from prison.
For the second time the annual accounting of the treatment caseload in England combines records of drug and alcohol use treatment, registering a continuing fall in total numbers and decreasing success with opiate users, while the treatment of drinkers appears to be improving.
Rewarding people dependent on illegal drugs for not using those drugs is a controversial tactic, one this review from the EU’s drug misuse centre found patchily effective in extending retention and reducing substance use as a supplement to medication-based treatments.
HOT TOPIC 2016 HTM file
Harm reduction: what’s it for?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Opposing agendas have led to a shifting balance between seeing harm-reduction as acceptable only in the service of the greater good of reducing or eliminating drug use, versus seeing it as the overriding objective, one which should never be sacrificed to an anti-drugs agenda.
Though set up to determine whether the public purse would gain by sending more opiate-dependent clients to residential rehabilitation, this UK government report declared itself unable to conclude one way or the other, but did judge it “highly unlikely” that these treatments’ extra expense would be offset by extra savings.
REVIEW 2015 HTM file
Prevention of addictive behaviours
Based largely on existing reviews, this report for the German Federal Centre for Health Education comprehensively assesses substance use prevention approaches. Among its many conclusions are that approaches based solely on information provision are ineffective, in contrast to the more positive evidence for lifeskills and multi-component community programmes.
Failure to find effects concentrated in the first two weeks after release persuaded analysts that widespread methadone prescribing in Scottish prisons from 2002 did not reduce the rate of drug-related deaths after release. But over 12 weeks the rate did fall substantially, and methadone treatment may have helped.
In the UK context, this study’s findings imply that to prevent new cases it is best to focus expensive new treatments for hepatitis C infection on injectors who infrequently share their injecting equipment – patients most likely to be found and recruited via needle exchanges and addiction treatment services.
Implication of this English study is that to save the lives of people dependent on heroin or similar drugs, they should be engaged and retained in substitute prescribing programmes like methadone maintenance until there is little risk of their relapsing after leaving. Shortly after leaving residential/inpatient settings was the highest risk period.
For the first time the annual accounting of the treatment caseload in England combines both drug and alcohol use patient records, registering a continuing trend down in total numbers due mainly to falls in users of heroin and other opiate-type drugs.
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