Pubdate: Wed, 18 Jun 2003
Source: Guardian, The (UK)
Copyright: 2003 Guardian Newspapers Limited
Contact:  http://www.guardian.co.uk/guardian/
Details: http://www.mapinc.org/media/175
Author: David Brindle

TOUGH LINE ON DRUG INJECTION PRINCIPLES

Tight restrictions have been set in the first official guidance on 
prescription of injectable heroin and methadone for hard-core drug users.

The potentially controversial guidance was issued by the national treatment 
agency (NTA) last Friday, as the government reshuffle dominated news 
agendas. But the guidelines - for specialist doctors - are worded with 
painstaking care and stress repeatedly the limited nature of their application.

"The message for specialist clinicians is that, yes, injectable heroin and 
injectable methadone have a role to play in the treatment of drug misuse - 
but it's a limited role and one that needs to be developed very carefully," 
says John Strang, chair of the NTA's heroin expert group and head of the 
National Addiction Centre.

The guidance was foreshadowed last month by David Blunkett, home secretary, 
who accepted that "radical thinking" was needed to engage hardened drug 
takers. But he said he expected no dramatic increase in the number of 
patients prescribed heroin - currently just 440.

Although heroin prescription for oral use "is and will remain" the most 
clinically appropriate form, the NTA asserts, injectable medication "may be 
appropriate for a minority who fail to benefit from oral maintenance 
programmes".

Injectable medication is "potentially more risky both for the patient and 
the public and should only be considered by a specialist and if there are 
adequate services in place, including supervised consumption of medication 
until the patient has stabilised", the NTA says.

The guidance lays down eight principles to be observed in connection with 
any prescription of injectable heroin or methadone. These include provision 
of an integrated care package for patients, so that injection is not 
sanctioned in isolation, and that other options are explored fully. 
Priority should be given to improving the effectiveness of prescription for 
oral use, the guidelines say.

On monitoring of injection, the guidance states: "Injectable drugs may 
present more risk of overdose than oral preparations, and have a greater 
street value on illicit markets, and hence may require greater levels of 
supervision."

Paul Hayes, NTA chief executive, says the guidance represents only part of 
an overall strategy to improve treatment for drug users. "Treatment is not 
just about prescribing a substitute drug. It's about the full range of 
services - including counselling, in-patient care, prescribing and aftercare."

Roger Howard, chief executive of charity Drugscope, says: "We welcome the 
NTA guidelines on heroin prescription and hope that they will lead to the 
situation found in other countries where, when other treatments have 
failed, there is an increase in users potentially being prescribed heroin."

The guidance is at: www.nta.nhs.uk 
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MAP posted-by: Keith Brilhart