HEROIN addicts should not be "parked indefinitely" on substitute drugs, such as methadone, according to new report produced by an expert group commissioned by the National Treatment Agency for Substance Misuse (NTA).
An estimated 150,000 (out of 265,000) heroin addicts in England are currently being treated using substitute medications, typically methadone or buprenorphine. The report calls for 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.
The group – chaired by Prof John Strang of the National Addiction Centre -- was set up in response to the government’s 2010 Drug Strategy, which called for substitution therapy not to be regarded as a long-term measure but a first step on the road to recovery.
Compelling scientific evidence shows that OST can be effective but the report cites a culture of commissioning and practice that does not give sufficient priority to the desire of individuals to overcome their dependence on drugs.
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 would 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 striving to achieve abstinence from problem drugs and ensure treatment programmes are dynamic and support recovery, with the exit visible to patients from the moment they walk through the door. Treatment services should also be integrated with other recovery support, such as mutual aid groups, employment services and housing agencies.
Prof Strang 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."
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