UK Government Injectable Opiates Prescribing Guidelines

Link here to the NTA (national treatment agency) UK injectable opiate prescribing guidelines

I've quoted below the most important parts... There is a lot of interesting information in the PDF so I would suggest reading through if you have an interest in the subject

This is taken from the PDF. The main message from the NTA is that the following eight principles should be adhered to when considering prescribing injectable opiates:

This link is the guidelines issued to my local NHS specialist addiction unit, it's specific to east London but the guidelines are probably applicable to most drug services nationwide.

        Principles guiding injectable maintenance prescribing

This guidance recommends that injectable maintenance prescribing should only be undertaken in line
with eight principles.

1. Drug treatment comprises a range of treatment modalities which should be woven together to
form integrated packages of care for individual patients.

2. Substitute prescribing alone does not constitute drug treatment. Substitute prescribing requires
assessment and planned care, usually with other interventions such as psycho-social
interventions. It should be seen as one element or pathway within wider packages of planned
and integrated drug treatment.

3. Within the substitute prescribing modality, a range of prescribing options are required for
heroin misusers requiring opioid maintenance. Some options may carry more inherent risks
than others (e.g. injectable versus oral options). Patients who do not respond to oral
maintenance drug treatment should be offered other options in a series of steps. This would
normally include:
• oral methadone and buprenorphine maintenance, specifically optimised higher dose
oral methadone or buprenorphine maintenance treatment, then
• injectable methadone or injectable heroin maintenance treatment (perhaps in
combination with oral preparations).

4. Injectable maintenance options should be offered in a local area that can offer optimised oral
methadone maintenance treatment including adequate doses, supervised consumption and
psycho-social interventions. This is essential to ensure oral drug treatment options have been
fully explored prior to a trial of injectable maintenance treatment and to ensure smooth
transition back to oral treatment if required.

5. Injectable and oral substitute prescribing must be supported by locally commissioned and
provided mechanisms for supervised consumption. Injectable drugs may present more risk
of overdose than oral preparations and have a greater value on illicit markets and hence may
require greater levels of supervision.

6. Injectable maintenance treatment is likely to be long-term treatment with long-term resource
implications. Clinicians should consider the move from oral to a trial of injectable preparations
carefully, including long-term implications for the patient and drug treatment systems and
involvement of services.

7. Specialist levels of clinical competence are required to prescribe injectable substitute drugs.
Heroin prescribing also requires a Home Office licence.
8. The skills of the clinician should be matched with good local systems of clinical governance,
supervised consumption and access to a range of other drug treatment modalities.



         Clinical eligibility

The expert group reached some consensus on eligibility criteria, precautions and outcome measures.
However, guidance on issues such as dose or the prescribing of combinations of oral and injectable
preparations will require further work.
The agreed criteria are set out in full and relate to factors such as:
• age and drug usage
• willingness to comply with conditions such as supervision and monitoring, engagement
in a range of care options, avoidance of some risky behaviours and of diverting prescriptions
into illicit markets
• persistence of poor outcomes within an optimised oral programme.


         Recommendations

The key recommendations are that:
• optimised oral methadone maintenance should be the maintenance treatment for
the majority of heroin users
• injectable heroin and methadone treatments should be considered only for the minority of
patients who are genuinely unresponsive to an optimised oral maintenance treatment approach
• injectable heroin and injectable methadone treatments based on this guidance should
be seen as a new drug treatment modality requiring the development of new integrated
care pathways.


         Key messages

The document has four key messages:
1. The prescribing of injectable substitute opioid drugs may be beneficial for a minority of heroin
misusers. The document makes preliminary recommendations on eligibility criteria.
2. Future maintenance prescribing of injectable heroin or methadone should only be undertaken
if it is in line with eight principles identified by the expert groups. This is essentially a new
standard of injectable drug treatment to that previously provided in England. Applying these
principles in practice, sets a high standard for delivery of this treatment intervention, in
recognition of the risks involved.
3. Services should be improving for patients already in receipt of injectable maintenance
prescriptions for heroin or methadone. Where patients are stable, maintaining this stability
is paramount.
4. Priority should be given to improving the effectiveness of oral maintenance treatment (on
methadone or buprenorphine) for the majority of patients in all drug action team areas in England.


         Clinical evidence

The following statements were agreed as consensus on ‘clinical evidence’ by the expert group based
upon many years’ experience of prescribing heroin and other injectable drugs.
Statements from the expert advisory group

1. We consider that the prescribing of injectable substitute opioid drugs, including heroin and
methadone ampoules, may be of benefit for a minority of heroin misusers. In principle this
should be part of a range of potentially available drug treatment options, provided it is set
in the context of a comprehensive drug treatment package.

2. We consider the prescribing of heroin and other injectable opiate maintenance treatment is
not a first-line treatment for dependent heroin users. Injectable opioid maintenance treatment
(including injectable heroin maintenance) is an exceptional treatment that should only be
considered for patients who have not responded to optimised conventional oral
maintenance treatment.

3. We consider that there may be greater inherent risks with injectable opioid treatment, when
compared with the better-studied oral methadone maintenance (and other treatments, such
as sublingual buprenorphine maintenance that has less risk of overdose). These include
greater risks of overdose, continued injecting harms and greater risks of diversion and abuse
of medication. Formal consideration of the risks and benefits of injectable opioid treatment
should be undertaken with all potential patients, particularly those who may be at highest risk.

4. We consider that these risks and dangers (to the individual patient and to society at large)
can be greatly reduced by adherence to practices and procedures which increase
compliance with treatment, and which reduce prescribing to inappropriate patients, erratic
use and diversion to the illicit market.

5. We consider the assessment of potentially suitable patients, and the subsequent initiation of
injectable opioid maintenance treatment, to be a task that requires considerable experience
and expertise in the addictions field, and which should consequently be undertaken by a
competent specialist doctor* working in an appropriately supported treatment setting.

6. We consider that the wider safe provision of injectable opioid maintenance treatment
requires substantial identifiable resources and facilities (as recently established in Switzerland
and the Netherlands). These are required in order to make possible the wider provision of
injectable maintenance treatment options and thereby achieve these greater potential benefits
to the patient and society whilst minimising adverse consequences.


           Cost and cost-effectiveness of injectable substitute prescribing

Injectable substitute drug treatment is a relatively expensive drug treatment option. Calculating cost
and cost-effectiveness of different types of drug treatment is complex and attempts to do so are
compounded by a lack of agreement on appropriate methodology. The NTA is engaged in further
work to provide more accurate and consistent unit costings of drug treatment modalities and options.
Strang et al (2003) estimated that injectable methadone represented 20 per cent of the methadone
prescription drug costs in 2001 for four per cent of treatments. Indeed injectable methadone and heroin
treatment has been estimated to cost between 5 to 15 times as much as oral methadone treatment,
depending on the content of treatment packages and arrangements to supervise consumption.
Surveys of clinicians indicate that the cost of injectable heroin in particular is a prohibitive factor. In
addition, it is recognised that the substitute prescribing of injectable heroin and methadone in the UK
appears to be a long-term treatment which may limit long-term cost-effectiveness.
The NTA will explore issues of cost in greater depth. However, cost factors indicate that commissioners
need to be able to ensure that the provision of injectable maintenance drug treatment does not
undermine the overall quality of care for all patients. Where adequate access to optimised oral drug
treatment options are not available to the majority of patients, it may be particularly difficult to
demonstrate this.
The potentially “high cost and low volume” nature of injectable maintenance drug treatment indicates
that it should be targeted at patients with high levels of need. These patients are, in any case, likely
to incur high levels of costs to health and social care systems.


          Inclusion criteria for injectable opioid maintenance

Clients should meet all of the following inclusion criteria in order to be eligible for injectable
opioid maintenance:
• The client should have a protracted history (> 3 years) of heroin dependence and regular
daily injecting.
• The client should be aged 18 or over.
• The client should be able to provide informed consent. This includes no active medical
or psychiatric condition impairing the patient’s capacity to provide informed consent
• The client should be willing to comply with the conditions of injectable opiate
treatment2, including:
• a treatment plan
• regular supervision and monitoring
• avoidance of persistent injecting in high risk areas (e.g. neck or groin veins)
• continuation of injectable treatment being conditional upon positive healthy response
to treatment (which includes other treatment elements in a package of planned,
co-ordinated care)
• diversion of the prescribed injectable drugs and “double scripting” being grounds
for discontinuation of injectable treatment.
• The client should first have received optimised oral maintenance treatment - an adequate
period (normally at least six months and for some this could be significantly longer) of
optimised conventional substitution maintenance treatment and associated package of care.
• There should be a persistence of poor treatment outcomes despite a current optimised oral
maintenance treatment episode. Indicators of poor outcomes may include:
• continued frequent (daily or almost daily) injecting of illicit heroin or other opioids
• patients at continuing high risk of the transmission of HIV, HBV or HCV to
themselves or others
• continuing injecting-related health problems (e.g. abscesses, cellulitis,
systemic infections), poor general health, poor psychosocial functioning and
drug-related criminality.
If the inclusion criteria are met injectable opioid maintenance treatment may then legitimately
be considered by the clinician, in consultation with the patient, key carers and the relevant
multidisciplinary team.
22

Getting Injectables Prescribed In The Uk

I'm currently in the process of helping a good friend who's having trouble with our local drug service. 

When I was using I know I could have done with someone on my side, advocating for me. So now I'm in a better position myself i thought I'd try and help.

So this is the situation, she is a long term user, around 20 years. IV heroin for most of it but speedballs, heroin and crack combined, for the last five years. Which I know from experience is a total bitch to kick. 

When I first started using, I used to hang with a guy that did both. He used to infuriate me because after hustling money, we'd go to score the heroin, I'd be chomping at the bit to use it! But this guy wouldn't do heroin without crack! Seriously, we'd have to wait around for hours sometimes for his crack dealer. He just point blank refused to do just the heroin and I just didn't get it! .... Fast forward 15 years and now I get it! I fell into the speedball trap too towards the end. It really is difficult to do just the heroin. It's just not the same. 

It's difficult to explain if you haven't experienced it, it's like toast without butter, or tea without sugar. Haha

It obviously also makes it that much harder to stop, you have a double whammy addiction!

I read somewhere about the physiological side of it. IV heroin or IV crack, alone, obviously induce a huge dopamine release, which gives the high. 

Put the two together however and the dopamine release is around 400% more!

It's an awful addiction to have, at least with just heroin, psychologically, you're on a pretty even keel. Yeah you have ups and downs, when you're sick and skint you feel crap but trust me, once you've been on speedballs you appreciate the difference. The crash after a day of using is just awful. It used to take me a week to recover from a speedball binge. Not even wanting to talk to anyone else, physically feeling awful but the psychological side of it is like nothing else. Well, maybe like an amphetamine come down,.. a bit..

When it's time to stop, you're not only battling cravings and physical symptoms of normal opiate withdrawal, you get the extra fun of cocaine cravings and withdrawal! Cocaine cravings are pretty intense on their own!

Like I said, double whammy! .... Why did you think it was a good idea to try a speedball again? ;)

So anyway, my mate is an old school addict. Been at it a long time, been in and out of rehabs and programmes. Spent the majority of her addiction on methadone, 180mg at the highest. In drug service terms anything over 60mg is classed as an 'optimised' dose. 60mg is believed to be the minimum to achieve a 'therapeutic effect', the 'optimised dose'. 

This has changed over the years, it wasn't too long ago that 60mg was considered a high dose!

Incredibly, in the United States, doses of up to 500mg daily aren't unheard of.

The most I have ever heard anyone being in here was 250mg. 

She tried subutex but didn't get on with it. Some people just don't get on with buprenorphine. It's a very different drug to methadone and heroin, pharmaceutically and subjectively. It's a semi-synthetic, partial opiate agonist/antagonist. 

It can feel quite 'chemically' to some people.  If you're used to full agonist opiates like heroin or methadone, the crossover to subs can be difficult. 

Right now she's frustrated with her treatment, she feels as though they have given up on her almost. A 'lost cause' .. It's very sad actually, this girl is an amazing person, really creative and kind. I've known her a long time, she's a little like me I guess, in that she's not really what you'd class as a 'junkie'. Having worked and supported herself, her kids and her habit most of her life. 

Like me, getting caught up in opiates using them almost like a sticking plaster, to deal with emotional pain. Opiates are great at numbing those painful memories some of us damaged people have. They were almost a natural progression for me, I'd spent most of my teens struggling with feelings and emotions that I just didn't have the tools to deal with. 

She's currently under the care of our local specialist addiction unit, at the hospital. This is where they send the people that don't respond well to traditional treatment, maintenance scripts which can be given by a key-worker at a community drugs service. 

They are, by definition, there to provide a specialist service, in my eyes you would think that that involves using a wider range of medications and psycho-social interventions like psychotherapy and family counselling. 

About a year ago, while I was still there actually, the budget was slashed.

Lots of NHS services were cut, obviously addiction services are an easy and obvious target and therefore one of the first to feel the pinch. 

The consultant that ran the unit for years was fantastic, I've written about her before I think. A really amazing, caring doctor. 

Part of the cuts included her having to incorporate the alcohol unit into the drugs unit. Splitting her time overseeing both units and pulling back on direct patient contact.  She wasn't prepared to make this compromise and ended up resigning, it was a travesty actually and makes me mad to this day. Things at the SAU really went downhill after she left. Every week I'd hear clients moaning in the waiting room, keyworkers would change from week to week, it became impossible to see a doctor and you could just tell that most of the staff couldn't really care anymore, they'd be out the door by 4.30 whereas in the past stayed til gone five.

Rather than clients seeing doctors, nowadays everyone sees a keyworker, no matter what their needs or level of priority. The keyworker is like the liaison between the client and 'the team'

The team consists of registrars, keyworkers, one psychologist (to cover every client), the consultants, the manager, nurse and various other workers. They meet weekly to discuss the clients. 

This may seem a sensible idea, and certainly streamlines things, but at what cost?

I know for me, when I was still there, I just felt a total lack of care or even interest. I had a different keyworker every appointment at one stage. They were obviously temporary agency staff, with no specialist training in the drugs field. One lady In particular was so obviously uninterested in me I played around a little and told her I was injecting benzos and that I was self harming again. To see her reaction. There was none.. She just wrote it down and moved on. I don't know what I was expecting really, maybe 'are you ok?' I guess..

Back to my mate.. She asked me to look up the government guidelines for injectable opiate prescribing. 

I have an interest in this too because I was looking into it for myself before I stopped using. 

It's a bit of a grey area, it's not a common practice, but technically it's possible to get an injectable script. The studies looking at injectable vs oral prescribing show positive outcomes, there is plenty of evidence from Europe, we all know about Zurich's incredible results with 'needle park'. They had a huge and very visible heroin problem some years ago, addicts would (infamously) stand out in the open, injecting eachother. 

They rather bravely, implemented an injectable opiates policy. Set up a clinic where addicts could go and get a legal, safe and regular supply of heroin. There were conditions attached of course, the addicts had to attend the clinic twice daily and inject in front of staff where they could be monitored to ensure they were injecting safely and to stop overdoses. Incredibly they cut their new addict numbers by around 80%. By taking the 'glamour' out of IV drugs, they essentially stopped people wanting to start using. They have similar places in Canada although these are just safe spaces to inject, with staff on hand dealing with OD's and to offer safer injecting advice. They don't prescribe here just supervise. Many many lives have been saved and local HIV and Hep C rates have dropped. 

Portugal have recently decriminalised the use of drugs, where before an addict would be punished through the courts and prison system, they started instead to offer them a place in rehab, or opiate replacement therapy. Again, they have proven the concept and cut drug related crime dramatically.

The glaringly obvious point here is that people will use drugs wether they are illegal or not, criminalising and punishing people for using DOESN'T WORK. Putting programmes and systems in place to help drug users is the only way to make a real difference. 

Although I don't personally need medical treatment anymore, it's not long ago that I did, and I feel strongly about the UK's and the rest of the western world's outdated and useless drug policies. The 'war on drugs' hasn't, and never will, work. 

I'm hopeful that things will change though, there is a small but rapidly emerging worldwide movement towards the decriminalisation of drugs. 

UK drug policy does allow for the off label prescription of injectable opiates for addiction. 

A home office licence is required to prescribe diamorphine though and there are only around 90 doctors that hold one. 

No licence is required to prescribe methadone amps though.

I feel my mate is a good candidate for injectable prescribing, after reading the NTA and NICE guidelines she fits the criteria. The only other things in the way are practical things like being able to demonstrate good injection technique and having good venous access. It's also necessary to monitor people closely who start this treatment. Especially during induction. It may not be logistically possible to prescribe at your local unit and this will have an impact on their decisions to provide injectables. 

Essentially though, the final decison rests with the prescribing doctor.  it literally is as simple as the personal prejudice, preference, experience and maybe even the whim, of the consultant. 

If you can demonstrate that you fulfil the criteria and you can show a good case for a realistic reduction in harm and improvement in illicit drug use, then there is really nothing stopping you pursuing it. 

Cost is another major factor, we all know oral methadone is cheap as chips. As low as 20p per dose. 

Currently there are around 5000 addicts receiving injectable methadone and around 450 diamorphine. Most of these people have been on it long term and were often inherited patients to the new doctor. Injectable scripts account for 80% of the total cost for methadone prescriptions.

Maybe some of you will think that I'm wrong. And that addicts shouldn't be given injectables. Maybe you're right. I just feel we should be given the option, if it works then all the better. 

As I keep saying, addiction is a complex, difficult issue, it is not a 'one size fits all' problem and treatment should be tailored to the client. Utilising all the treatment options, including medications. 

Trial results show a large amount of people either coming off opiates altogether or achieving a significant reduction of illicit drug use. That can't be a bad thing no?

If people aren't needing to commit crimes to get their drugs anymore doesn't society in general benefit?

News article last night about diamorphine prescribing in London

http://www.bbc.co.uk/news/uk-england-london-14016887

This news piece is actually pretty shockingly biased... for the BBC!

They quote the diamorphine prescribing had a 6% success rate in getting people clean versus oral methadone also at 6%!

Now I don't know where they're getting they're facts from but the accurate RIOTT results are here
and here

And to top it off, they wheeled out Anne bloody Widdicoombe to tell us that we shouldn't be giving junkies a free hit on the state! ... again .. by the same argument we should then not be giving smokers nicotine patches!

From the article:

Supervised administration of injectable ‘medical’ grade heroin leads to larger reductions in street heroin use in chronic heroin addicts who are failing on treatment, than does either injectable or oral methadone. The findings of the Randomised Injectable Opiate Treatment Trial (RIOTT )  trial are reported in an article in this week’s Lancet, written by Professor John Strang and colleagues from the  National Addiction Centre, Institute of Psychiatry (IoP), King’s College London (KCL).
At least 5–10% of heroin addicts fail to benefit from established conventional treatments but whether they are untreatable or just difficult to treat is unknown. A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.
This randomised controlled trial looked at chronic heroin addicts who were receiving conventional oral treatment but continued to inject street heroin regularly. Patients were assigned to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three National Health Service (NHS) supervised injecting clinics in England (London, Brighton, Darlington). During weeks 14–26 50% or more tested negative for street heroin on weekly random urine analysis.
The researchers found that at 26 weeks, 80% of patients remained in assigned treatment - 81% on supervised injectable methadone, 88% on supervised injectable heroin and 69% on optimised oral methadone. Proportions of patients achieving 50% or more negative samples for street heroin were highest in the injectable heroin group (66%) followed by injectable methadone (30%) and oral methadone (19%).  The measure of measurable improvement, the pre-selected primary outcome, was that through Months 4-6, at least 50% of randomly collected urines tested negative for street heroin (from weekly random urine analysis).  The authors report on 'abstinence from street heroin' also, and a similar greater benefit of the supervised heroin treatment was seen, compared with the other two treatments.
The authors say: 'We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment.'
They conclude: 'Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment’, is detailed in the UK Government’s 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.'
Professor Strang said: 'Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward.  The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within 6 weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.'
The National Addiction Centre is jointly run by the IoP KCL and South London and Maudsley NHS Foundation Trust (SLaM). Both are part of King's Health Partners, an Academic Health Sciences Centre (AHSC) for London, bringing together clinical and research expertise across both physical and mental health. For more information, visit www.kingshealthpartners.org.   
The article ‘Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial’ can be found here, along with a podcast featuring Professor Strang discussing the trial:  www.thelancet.com.  Professor Strang can be seen also on the new SLaM website talking about RIOTT: http://www.slam.nhs.uk/news/latest-news/treating-heroin-addiction.aspx.

Reply From The Government About Diamorphine Prescribing

Heres the reply I just got from the department of health from the letter I sent last month... pretty vague if you ask me...


Heres the original letter I sent of: Plese feel fee to edit:

                                                                                ......./......./2010

Dear (Insert MP’s name here),

               

                 I am writing with regards to the current treatment modality of heroin addiction in the UK.

After personally using heroin for 15 years and having utilising the various treatment options currently available believe I have a fair understanding of the issues surrounding opiate addiction and treatment.

In my experience, and invariably of many others, maintenance treatments like methadone and subutex, have their place, but for the majority of addicts just don’t work, one report suggests a success rate of just 4% with methadone!

There are numerous government reports supporting the prescribing of diamorphine for heroin addicts, and the studies and trials that have been done all have much better results regarding health problems and a marked reduction in crimes committed to support habits.

The UK is also in a better position legally than most other countries as doctors here are allowed to prescribe diamorphine for addiction (alebeit with a home office license) this should be exploited as there are hundreds of thousands of heroin addicts in the UK that can see no way out of their situation.

After a recent heroin ‘drought’ in the UK, a lot of addicts are questioning the range of treatments available to us.

Not only is the situation regarding getting into a treatment programme different all over the country, the choices on offer (methadone or subutex maintenance are not suitable for everyone)

For example, some GP’s will prescribe on the same day, but in other areas users will have to join a drug dependency unit and be co-prescribed with a GP, this on average can take six to eight weeks which is just too long, typically when an addict asks for help, they are at ‘rock bottom’ and need it immediately.

In our class culture, if a user can afford it, a lot of private doctors will prescribe morphine, diamorphine or benzodiazepines with no questions asked. How is this fair to the average addict?

I feel (along with many others) we are made to jump through so many hoops it almost isn’t worthwhile. Even if we do what is asked of us we are only going to get a drug which is more addictive than heroin, has more side effects, is a lot harder to detox from and in most cases doesn’t even alleviate 100% withdrawal symptoms and cravings!

I believe it is time the government looks at other options. Methadone and subutex do not work for the majority of addicts. There are plenty of other options out there and we need to stop looking at addiction with a ‘one size fits all’ attitude.

Addiction is obviously a very complex, difficult issue to treat, many of us have deep psychological issues, whether it be from childhood abuse, or pre-existing depression that we discovered was manageable through opiates.

It is proven that opiates alleviate depression. It’s time we were treated with dignity and respect, like any ‘normal’ patient would get.

Currently, your average heroin user is forced to buy on the streets from unscrupulous criminal gangs that will, as standard ‘cut’ heroin with all kinds of adulterants, putting users at risk from poisoning.

Not only would being treated properly with appropriate medication put a stop to health problems associated with injecting/smoking adulterated heroin, there would be a marked drop in drug related crime, prostitution, gang affiliated violence and profiteering.

I believe we need to re-asses the way we currently treat addicts, if users want to use methadone it should be made easier and faster to access, injectable ampoules should be made available to those who want it as needle fixation is a big part of many addicts’ problem.

Injectable diamorphine should be the standards treatment for addicts that inject and for smokers, in tablet form.

A clean supply of these drugs would massively reduce the problems classically associated with heroin addiction.

It would also mean users would be able to lead a relatively ‘normal’ life, get back into employment and attain some level of dignity as the daily routine of getting money, buying drugs would no longer be an issue!

I realise this is a highly controversial issue and will not change overnight but I believe we need to move out of the stone age when it comes to the treatment of addiction

Yours Sincerely

(Name/Or I guess it could be anonymous?)

Send one off yourself too!



miltona@parliament.uk
anne@annemilton.co.uk


Theresa May's email address (current person responsible for drugs policy/strategy) - mayt@parliament.uk

Dear Mr ********,

Thank you for your email of 6 December to Anne Milton about the prescribing of diamorphine to those dependent on drugs.  I have been asked to reply.

The Department is grateful for your email outlining your experiences of drug dependency and treatment.   

Although treatment is not a ‘one size fits all’ system, it is important to understand that high quality treatment is the most effective way to address drug dependency.  Having independently evaluated methadone and buprenorphine, the National Institute for Health and Clinical Excellence has recommended that substitute prescribing with either methadone or buprenorphine, delivered in tandem with psychosocial treatments (such as talking therapies), should be the frontline treatment for opioid dependency in the UK.  However, the Department shares your concern that in the past methadone may not have been used appropriately or to the full benefit of patients.  The Department wants to see treatment helping those who are dependent on drugs to full recovery, reducing the harmful effects that drugs have on both individuals and the wider society and enabling them to contribute productively to society.

On 8 December 2010 , the Department published a new Drugs Strategy, ‘Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life’.  This puts a greater emphasis on supporting those who are drug dependent to achieve recovery and on enabling local community providers to help those who are drug dependent to achieve better outcomes.

An electronic copy of the strategy can be found on the Home Office website at:

http://www.homeoffice.gov.uk

and by entering the title of the publication in the search bar and following the links.

You may also be interested to know that the National Treatment Agency for Substance Misuse has recently set up an expert group, chaired by Professor John Strang of the National Addiction Centre, to develop a clinical consensus and protocols for substitute prescribing.  This will focus practitioners and clients on abstinence and long-term recovery, and prevent unplanned drift into long-term maintenance.

Yours sincerely,

Edward Corbett
Customer Service Centre
Department of Health'