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Injectable opiate prescribing in Cornwall

  • Rupert White (a1) and Lizzie Shearman (a2)
Abstract
Aims and Method

To compare local practice with national guidelines, examine the areas of divergence, and establish complication rates for methadone and diamorphine. Fifty-one patients from Cornwall treated with injectable methadone or diamorphine were interviewed using a standard questionnaire.

Results

Fewer problems were reported by individuals using injectable diamorphine, though for both drugs intramuscular injection was more problematic than intravenous injection. Injections into the groin were common, as was problem drinking.

Clinical Implications

Intramuscular administration of medications may be more likely to cause abcesses or cellulitis. Ongoing groin injecting and alcohol misuse is common, but should probably be tolerated if other harm reduction benefits accrue. It may be prohibitively expensive to set up injecting rooms in rural parts of the UK and future policy should reflect this.

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Copyright
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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Lintzeris, N., Strang, J., Metrebian, N., et al (2006) Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK. Harm Reduction Journal, 3, 28.
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Strang, J. & Gossop, M. (1994) Heroin Addiction and Drug Policy: the British System. Oxford University Press.
Strang, J., Sheridan, J. & Barber, N. (1996) Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales. BMJ, 313, 270272.
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White, R., Cox, D. & Charnaud, B. (2005) Lessons from the ongoing UK injectable diamorphine shortage. Addiction, 100, 17411742.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Injectable opiate prescribing in Cornwall

  • Rupert White (a1) and Lizzie Shearman (a2)
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eLetters

Injectable Opioid Prescribing in Oxfordshire

Joseph El-Khoury, Specialty Trainee 5
16 April 2009

Dear Sir

We sought to replicate the audit on the prescribing of injectable opiates undertaken by White and Shearman in Cornwall (Psychiatric Bulletin, October 2008, 32, 387-390). The Specialist Community Addiction Service covers the county of Oxfordshire. We identified 19 patients (14 Males and 5 Females) on regular injectable Opioid prescriptions: 10 Diamorphine (53%), 5 Methadone (26%), 2 Pethidine (11%) and 1 Morphine (5%). Of these, 17 were interviewed using a slightly modified version of the audit tool kindly provided by White and Shearman. Only one person had been started on a script in the last four years while others had been on this type of treatment for an average of 9.5 years (STD= 4.1). Three patients, all females, had been dependent on prescribed injectable opioid analgesics. The other 14 had been Heroin users for an average of 15.8 years (STD= 6.3) before being started on an injectable prescription. Compared with Cornwall, our audit reveals an older group of users who had been started on injectable scripts after lengthy periods of oral substitution treatment (9.2 years, STD= 6.1). The Oxfordshire cohort was also relatively more stable with no reports of overdoses whilst using the prescribed drug or additional opiate use in the previous month. Alcohol consumption was also low with only 2 clients reporting problematic levels of drinking. When asked, 47% said they had no intention to ever come off the script; 29% would consider it in 5 years and 24% in 1 year. The clients, regardless of the drug injected, were approximately evenly split between almost exclusive Intramuscular (IM) or Intravenous (IV) use with little crossover. Around half the patients reported experiencing any harmful physical consequences from prescribed injectable opiates. Occasional abscesses were the main problem faced by those injecting IM, while IV injectors reported abscesses, deep vein thrombosis and cellulitis. All had found access to medical care when needed. The overwhelming majority claimed to consistently use clean needles but the answers were more equivocal with regards to sterile injecting technique. Direct supervision of injecting techniques was minimal with only 2 clients (11%) remembering having been observed on one occasion by their GP or another health professional. In conclusion, we found interesting similarities between the client groups in Oxford and Cornwall which might indicate that a clinical rationale for providing injectable opiates to a niche population exists and that it transcends geographical and social regional differences.

*Dr Joseph El-Khoury Specialty Registrar 5 in Adult Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Oxford Specialist Community Addiction Service, The Rectory Centre, Rectory Road, Oxford OX4 1DU. Tel: 01865455671, Fax: 01865455633Email: Josephelkhoury@doctors.org.uk

Dr Andrew McBride Consultant in Addiction Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation NHS Trust, Oxford Specialist Community Addiction Service, The Rectory Centre, Rectory Road, Oxford OX4 1DU

Word count: 395

References

WHITE, R., SHEARMAN L. (2008) Injectable Opiate Prescribing in Cornwall. Psychiatric Bulletin, 32, 387-390
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Conflict of interest: None Declared

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