Overcoming heroin addiction
Posted on 05/07/2012
Leading doctors and other experts in drug dependence today launched a ground-breaking report on the proper ways in which prescribing medication can help heroin addicts break the hold of their addiction and recover from dependence.
The expert group made clear that heroin addicts should not be parked indefinitely on substitute drugs, such as methadone, and all prescribing treatments should be regularly reviewed.
The report is the product of a two-year inquiry by GPs, psychiatrists, psychologists, nurses, service users, and providers from both the NHS and voluntary sectors, and was chaired by Professor John Strang, Director of the National Addiction Centre at King’s College London and the South London and Maudsley NHS Foundation Trust.
The group called for immediate remedial action to ensure that opioid substitution therapy (OST) is always delivered in line with clinical guidance in order to optimise its effectiveness, enable patients to quit street drug-use, and support recovery from addiction.
Professor Strang, who is also Head of the Addictions Department at the Institute of Psychiatry at King’s said: ‘Overcoming heroin addiction is often very difficult, but with the right support, more people can and will recover from dependence. Substitute prescribing has an important contribution to make to recovery-orientated drug treatment, but it is not an end in itself. More needs to be done by all of us in the health profession to ensure that users are signposted, supported and encouraged to overcome dependence whenever possible, and to reintegrate into society.’
There are an estimated 265,000 heroin addicts in England, of whom 165,000 are currently being treated. About 150,000 of these are prescribed a substitute medication, typically methadone or buprenorphine, as part of their treatment.
The expert group was set up in response to the coalition government’s 2010 Drug Strategy, which said too many people risked remaining on a substitute prescription when it should be the first step on the road to recovery.
Although the group highlighted the compelling scientific evidence that OST is effective, it also acknowledged there was a culture of commissioning and practice that did not give sufficient priority to the desire of individuals to overcome their dependence on drugs.
The authors of the report write: ‘Most people who enter treatment want to recover and break free of their drug dependence. We can help more to realise this ambition if we can ally safe, evidence-based recovery-oriented practice to the public health and wider social benefits we already accrue from treatment.....There is no justification for poor quality treatment anywhere in the system. It is not acceptable to leave people on OST without actively supporting their recovery and regularly reviewing the benefits of their treatment (as well as checking, responding to, and stimulating their readiness for change).’
The expert group rejected imposing time-limits on treatment, warning that arbitrarily curtailing or limiting the use of substitute medication would prevent addicts from sustaining their recovery, and most likely lead to increases in the spread of blood-borne viruses, drug-related deaths and crime.
However the group advised doctors and health professionals working with heroin addicts to:
- Review all existing patients to ensure they are working to achieve abstinence from problem drugs;
- Ensure treatment programmes are dynamic and support recovery, with the exit visible to patients from the moment they walk through the door;
- Integrate treatment services with other recovery support such as mutual aid groups, employment services and housing agencies.
Paul Hayes, chief executive of the NTA, said: “This report acknowledges that long-term international studies suggest currently only a minority of heroin addicts fully recover. Our ambition is for the English treatment system to become a world leader in delivering recovery outcomes, ensuring every individual in treatment is given the opportunity to leave addiction behind.”
The report 'Medications in recovery: re-orientating drug dependence treatment' is available at www.nta.nhs.uk