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Commentary on: New guidelines for prescribing injectable heroin in opiate addiction

  • Eilish Gilvarry (a1)
Extract

Until recently, the UK led the addiction field worldwide as the only country to prescribe diamorphine for the treatment of opiate drug dependence. However, the approach was inconsistent, with development conducted in a haphazard and arbitrary manner (Audit Commission, 2002), with variation in criteria, individualistic approaches and many doctors ‘inheriting’ patients on these long-term prescriptions from other doctors. There were relatively few restrictions once the doctor had been granted a licence by the Home Office.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Advisory Council for the Misuse of Drugs (2000) Reducing Drug Related Deaths. London: Stationery Office.
Audit Commission (2002) Changing Habits: The Commissioning and Management of Community Drug Treatment Services for Adults. Wetherby: Audit Commission Publications.
Department of Health (1999) Drug Misuse and Dependence: Guidelines on Clinical Management. London: The Stationery Office.
Home Office Drugs Strategy Directorate (2002) Updated Drug Strategy. Available at http://www.drugs.gov.uk.
Hartnoll, R. L., Mitcheson, M. C., Battersby, A., et al (1980) Evaluation of heroin maintenance in controlled trial. Archives of General Psychiatry, 37, 877884.
Luty, J. (2005) New guidelines for prescribing injectable heroin in opiate addiction. Psychiatric Bulletin, 29, 123125.
Metrebian, N., Carnwath, T., Stimson, G., et al (2002) Survey of doctors prescribing diamorphine (heroin) to opiate-dependent drug users in the United Kingdom. Addiction, 97, 11551161.
National Treatment Agency (2003) Injectable heroin (and injectable methadone): potential roles in drug treatment (www.nta-nhs.uk).
Stimson, G. & Metrebian, N. (2003) Prescribing heroin: what is the evidence. Joseph Rowntree Foundation (www.jrf.org.uk).
Strang, J., Marsden, J., Cummins, M., et al (2000) Randomised trial of supervised injectable versus oral methadone maintenance: Report of feasibility and 6 month outcome. Addiction, 95, 16311645.
Uchtenhagen, A., Dobler-Mikola, A., Steffen, T., et al (1999) Prescription of Narcotics for Heroin Addicts. Main Results of the Swiss National Cohort Study. Basel: Karger.
van Den Brink, W., Vincent, M., Hendriks, V. M., et al (2002) Medical Co-Prescription of Heroin: Two Randomized Controlled Trials. Utrecht: Central Committee on the Treatment of Heroin Addicts (www.ccbh.nl).
van Den Brink, W., Hendricks, V. M., Blanken, P., et al (2003) Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ, 327, 310312.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Commentary on: New guidelines for prescribing injectable heroin in opiate addiction

  • Eilish Gilvarry (a1)
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eLetters

Choice of evidence and evidence of choice

Andrew Al-Adwani, Psychiatrist
12 May 2005

Sir: In the community drug use is essentially demand led, given the impotence, idiocy and profligate expense of prohibition based policy, but in the NHS drug use is supply led. The type, dose and form of drug supplied by many NHS prescribers is at best whimsically evidence based andat worst arbitrary and severely limited. In the community drug users havewhat the NHS strives to achieve; patient choice. Patient choice is rarelymuch of an issue for substance misuse prescibees, apart from the choice toaccept the treatments offered or get nothing. The prescription of heroin may indeed be a useful intervention but if patient choice is is left out of the decision to prescribe heroin (rather than methadone or buprenorphine) and the options chosen are based on how 'badly' a patient is dependent then this treament will be restricted to those with the worstprognosis. On the other hand, if patient choice is a key determinant in deciding what treatment to offer then clinics will be overwhelmed by patients wanting heroin as their treatment of choice. Artificially limiting demand by making the use of prescribed heroin absurdly difficult (particularly in rural areas, for those with families to care for and for those with jobs)is an unresponsive attitude that smacks of hypocrisy and it's bedfellow religious moralising. The problem for honest prescribers is that what we are left with is rationing a treatment on the basis of a crystal ball type analysis. I hope to think that the majority of those who are reluctant to prescribe heroin desist due to the inherent unfairness in deciding whose choice it is. ... More

Conflict of interest: None Declared

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