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. It was chaired by one of Britain’s leading addiction specialists, Prof John Strang of the National Addiction Centre.
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.
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 report said: “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.
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.”
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 comprises the main body and three appendices, two of which are available separately.
For further information contact the NTA press office on 020 7972 1921/2 or out of hours call 07795 036460
About the expert group:
On behalf of the Department of Health, the NTA asked Prof John Strang of King’s College, London, in August 2010 to examine how the range of treatments used in drug addiction could have a clearer orientation towards recovery. Prof Strang published an interim report in July 2011 which set out a checklist of practical steps for practitioners to take.
The members of the expert group are:
- Mike Ashton – editor, Drug and Alcohol Findings
- Dr Alison Battersby – psychiatrist, Plymouth
- Dr James Bell – physician, South London and Maudsley
- Dr David Best (to June 2011) – University of West Scotland, now moved to Monash University, Melbourne, Australia
- Karen Biggs (from October 2011) – chief executive, Phoenix Futures
- Dr Owen Bowden-Jones – head of addictions faculty, Royal College of Psychiatrists
- Jayne Bridge – nurse, Mersey Care NHS Trust
- Anne Charlesworth – commissioner, Rotherham
- Professor Alex Copello – psychologist, Birmingham
- Dr Ed Day – psychiatrist, Birmingham
- Selina Douglas – commissioner, Westminster (to July 2011)
- Vivienne Evans – chief executive, Adfam
- Professor Eilish Gilvarry – psychiatrist, Newcastle, Tyne and Wear
- Jason Gough – service user representative, Sheffield
- Kate Hall – NHS service director, Greater Manchester West
- Dr Linda Harris – clinical director for substance misuse, Royal College of General Practitioners
- Dr Michael Kelleher – psychiatrist, South London and Maudsley
- Dr Brian Kidd – psychiatrist, Scotland
- Tim Leighton – psychologist, Action on Addiction
- Peter McDermott – service user representative, The Alliance
- Professor Neil McKeganey – Centre for Drug Misuse Research, Glasgow
- Dr Luke Mitcheson – psychologist, South London and Maudsley NHS Trust
- Dr Gordon Morse – GP, Somerset
- Morag Murray – NHS service director, Sussex
- Noreen Oliver – chief executive, BAC O’Connor
- Professor Steve Pilling – NICE and NCCMH
- Dr Roy Robertson – GP and academic, University of Edinburgh
- Ian Wardle – chief executive, Lifeline
In addition, the group consulted with a number of international experts. Two leading authorities in the US, Prof Thomas McLellan of the University of Pennsylvania Treatment Research Institute and William L White of Chestnut Health Systems, have written a commentary on the work of the group which will be published shortly in DrugLink magazine.
About Professor John Strang (MBBS, FRCPsych, MD, FRCP, FAChAM)
Professor Strang is Director of the National Addiction Centre (NAC) and Head of the Addictions Department at King’s College London (KCL) and is also Leader of the Addictions Clinical Academic Group of the Kings Health Partners AHSC (Academic Health Science Centre). NAC is a joint enterprise between South London and Maudsley NHS Foundation Trust and KCL Institute of Psychiatry. He has been a Consultant Psychiatrist in addictions treatment for over 30 years, and has extensive experience as a lead clinician in charge of a wide range of treatments in community and residential settings. His area of particular clinical expertise is around heroin addiction and associated complications, and the relationship between science, policy and clinical practice. He chaired the NICE Guideline Development Group on ‘Drug Misuse: Psychosocial Interventions’ (2007), and the Working Group for the 4 national Health Departments preparing the 'Clinical Guidelines for the Management of Drug Dependence and Misuse' (Orange Guidelines) (2007) as well as the Expert Group on Recovery-Orientated Drug Treatment. Professor Strang has published over 400 scientific papers in the addiction field and is one of only a handful of addictions researchers outside North America to be identified by ISI (the Institute for Scientific Analysis) as a “Highly Cited Author” – publicly available at www.ISIhighlycited.com – and he is the only one in Europe who is also a clinician.
About the NTA
The National Treatment Agency for Substance Misuse (NTA) is a National Health Service (NHS) special health authority which aims to improve the availability, capacity and effectiveness of drug treatment in England. From April 2013, the NTA’s core functions will transfer to Public Health England, and the NTA will cease to exist as a separate organisation. The NTA provided the secretariat for the expert group.