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Heroin substitute supervision saves lives

24 September 2010

At a time of growing heroin addiction problems and expanded methadone prescribing, research by Institute of Psychiatry (IoP) at King's, published in the British Medical Journal, has identified that supervision of methadone prescribing has substantially reduced deaths among users of the heroin substitute,

It has long been known that treatment with methadone reduces deaths among heroin addicts but there have been historic concerns about misuse and overdoses of methadone itself.

'We've been able to identify, for the first time, dramatically reduced mortality from deaths involving methadone, despite the recognised high risk of early death in this population,' says Professor John Strang of the National Addiction Centre, jointly run by IoP at King's and South London and Maudsley NHS Foundation Trust.

'We are now achieving the positive benefits from this treatment with much lower risk of the negative complications.'

'And the key determinant is the introduction of supervised administration of methadone in controlled doses. That prevents stockpiling, which reduces the opportunity for overdosing or passing on methadone to others who are equally at risk.'

The research found that changes in methadone prescribing practice in the 1990s, particularly the introduction of daily supervision of doses in the early stages of treatment, have been highly effective in making methadone treatment safer - achieving a fourfold reduction in deaths involving methadone across England and Scotland. It also suggests that other changes to treatment could further reduce over-dosing from 'opioids' - heroin and synthetic substitutes. Opioids are implicated in over three-quarters of all illicit drug related deaths in the UK.

The research team developed a new measurement tool 'OD4' which measures deaths per million daily doses of methadone prescribed in a year. The study covering 1993 to 2008 looked at the effects of the introduction of supervised dosing of methadone from in Scotland (1995-2000) and England (1999-2005) and found methadone deaths per million doses declined at the same time as there was an 18-fold increase in methadone prescribing in Scotland, and a 7-fold increase in England.

The National Addiction Centre (NAC), is jointly run by the Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust - both part of King's Health Partners Academic Health Sciences Centre.

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