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From the USA, a rare randomised trial found in favour of continuing methadone maintenance when patients entered prison rather than compulsory withdrawal. The potential benefits were most apparent in the near-100% continuation of protective treatment during the highly overdose-prone weeks after leaving prison.
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.
Strongest support for ‘therapeutic community’ approach to incarceration-based drug treatment according to robust review of evidence – with consistent reductions found in both drug relapse and recidivism.
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.
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.
From the USA’s professional society for clinicians and allied professionals in the field of addiction medicine, comprehensive recommendations on how doctors can use medications to treat addiction to heroin and other opioids.
Long-acting injectable naltrexone blocks the effects of opiates for about a month and has also helped dependent drinkers cut back. Treatment records in the US state of Missouri showed that among the few problem substance using offenders allocated to or who chose this treatment, a much higher proportion became abstinent than those offered other kinds of addiction treatment.
Maintenance prescribing of drugs like methadone to heroin-dependent prisoners seems to reduce injecting and the sharing of injecting equipment, changes which should reduce the risk of becoming infected with HIV.
Largely due to the treatment's health benefits, this review argues that failure to implement effective opioid maintenance programmes in prison represents an important missed opportunity to engage high-risk drug users in treatment, at possibly substantial costs both to individuals and to the community.
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