Dear Deirdre,

Your correspondent Laura Graham asks some big questions about Prof John Strang's review of prescribing practice (Addiction Today, September/October Vol 22 no 132), so here are the answers.

The NTA is leading this review because ministers asked us to. The Drug Strategy 2010 said: "for too many people currently on a substitute prescription, what should be the first step on the journey to recovery risks ending there: this must change."

Whether Laura loves this or loathes it is a personal matter for her, but the fact remains that substitute prescribing is recommended by the National Institute for Health and Clinical Excellence for the treatment of heroin addiction.

The pressing issue is how to prevent prescribing from drifting into unplanned maintenance, something I would have thought that readers of Addiction Today would support.

Or as your other correspondent, Sarah Garnham, said in the same edition: "In my opinion, methadone should only be carefully prescribed with regular reviews, considering individual needs."

We asked Prof John Strang to chair the review because as head of the National Addiction Centre he is one of the foremost authorities on addiction in this country.

In our view he was best-placed to undertake the task of seeking a clinical consensus to focus practitioners and their clients on long-term recovery as the desired outcome of treatment.

As Laura Graham points out, this was a central plank of the NTA's Business Plan for 2010-11. As to its role in the transition to Public Health England, the Action Plan for the NTA 2011-12 confirmed that it was a piece of work the Department of Health specifically wanted us to take forward during the interim period.

Finally, Laura resurrects "the debate around the NDTMS definition of drug-free as being on drugs" – a discussion which is helpfully confined to the pages of Addiction Today. 

Everyone else in the treatment field understands that anyone on a script cannot be drug-free since "drug-free" is a category of successful treatment completion. If someone is on substitute prescribing they are still in treatment. This so-called "debate" is therefore meaningless.

Yours sincerely,

Paul Hayes
Chief Executive
NTA