Treatment for heroin addiction should have more focus on supporting patients to recover from their dependency, says the country’s top addictions expert.

In an interim report for the National Treatment Agency (NTA), Professor John Strang, head of the National Addiction Centre, signals the direction of new clinical guidance for treating the estimated 260,000 heroin addicts in England.

As chair of an expert group looking at how the range of treatments used in drug addiction can have a clearer recovery orientation, Prof Strang recommends that treatment should: 

• incorporate wider social interventions as well as medication to support recovery outcomes
• include considered provision of medications including opiate substitution treatment (OST) to gain maximum benefit
• guard against incorrect provision or unnecessary drift into long-term maintenance on substitute prescriptions

In a checklist of good practice based on the scientific evidence, Prof Strang recommends that clinicians working in drug treatment should review all their patients to ensure they are working to achieve abstinence from their problem drugs, and give them the opportunity to come off medication when they are ready to do so.

The report updates the coalition Government about the work of the expert group after the 2010 Drug Strategy called for more recovery activities for those on a substitute prescription, and an increase in the numbers of heroin users leaving treatment free of their drugs of dependency.

The expert group will publish its full report and guidance early next year, but in his interim report on Recovery-Oriented Drug Treatment Professor Strang said: “The drive in recent years to reduce waiting lists and retain people in treatment has generally been successful with the result that much larger numbers of patients with addiction problems now enter treatment. This has undoubtedly been accompanied by significant benefits for many patients and the communities in which they live.

“However, the desire of clinicians to secure these benefits has led, in some instances, to over-reliance on medication and patients being allowed to drift into long-term maintenance. As a consequence, insufficient attention may have been paid to reviewing the actual benefits gained, reconsidering alternative methods to maximise the prospect of personal recovery, and adjusting treatments so that greater recovery could be achieved.

“The prescribing of any medication (and perhaps especially of OST) must not be allowed to become detached and delivered in isolation from other crucial components of effective treatment. Other elements of overall care need also to be considered, including individual recovery care planning, psychosocial interventions and integration with mutual aid and peer support. All of these, in different combinations with different patients, and adjusted over time, can and do support recovery.” 

Professor Strang makes clear that while treatment needs to concentrate on helping users overcome their dependence, clinicians must also be wary of the threat of relapse.  By calling on the full range of psychosocial and pharmacological approaches, the risk and severity of any setbacks to recovery can be reduced.  

Notes

For further information please contact:
Lynne Nasti
National Treatment Agency,
Senior Communications Officer (Media)
Tel: 020 7972 1920 Mob: 07747 535961 (also out of hours)
lynne.nasti@nta-nhs.org.uk

From the Drug Strategy
“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. We will ensure that all those on a substitute prescription engage in recovery activities and build upon the 15,000 heroin and crack cocaine users who successfully leave treatment every year free of their drug(s) of dependence.”

From the NTA Action Plan:
[We will] “Work with an expert group of clinicians and other interested parties, led by Professor John Strang, to develop a clinical consensus to focus practitioners and clients on long term recovery as the desired outcome of treatment, and prevent drift into unplanned maintenance.”

[We will] “Publish an interim report outlining the shape of protocols and guidance to challenge assumptions and change practice to make the system more dynamic.”

The Transition to Public Health England
When it published the NHS white paper last year, the government announced that as part of the reforms proposed, the NTA would cease to exist as a separate organisation and its key functions would be transferred to a new national service, Public Health England (PHE). The companion public health white paper subsequently made clear that reducing drug use, and enabling people to overcome dependency, recover fully and contribute to society, would be a key priority for this new public health service. The Department of Health is now taking forward the transition to PHE, under which services will in future be commissioned by local authorities through Directors of Public Health, supported by Health & Wellbeing Boards. During the interim period the NTA will drive the transformation from a ‘treatment system’ to a ‘recovery system’ to provide a solid foundation on which PHE can build.

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 and is also Leader of the Addictions Clinical Academic Group of the Kings Health Partners AHSC (Academic Health Science Centre).   He has been a Consultant Psychiatrist in addictions treatment for over 30 years, has led the group at the South London and Maudsley NHS Foundation Trust for many 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.

Professor Strang completed his undergraduate medical (MBBS) and postgraduate psychiatry studies at Guy’s Hospital. He trained in psychiatry at the Maudsley/Bethlem Royal Hospital between 1976 and 1982 and held Consultant Addictions Psychiatrist posts in Manchester (1982-1986) and London (1986 onwards).  In 1995, he was awarded a thesis-based Higher Degree (MD) at the University of London.

Clinical interests: Professor Strang has worked in, and with, an extremely wide range of types of treatment and rehabilitation services, psychosocial as well as medication methods.  This includes detoxification and OST maintenance treatments, community, inpatient and residential rehabilitation settings, individual and public policy approaches, and voluntary/third sector as well as statutory agencies.

Policy and Practice: Professor Strang has already previously contributed to influential clinical guidelines and reports.  He chaired the NICE Guideline Development Group on 'Psychosocial Aspects of Treatment of Drug Dependence and Misuse' (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 current DH/NTA Expert Group on Recovery-Orientated Drug Treatment.

Research interests: include new approaches to preventing heroin overdose deaths, involving family members; developing a UK evidence base for contingency management and incentives in addiction treatment; testing new interventions for entrenched heroin addicts previously non-responsive to treatment; collaborative international review of global science evidence base.

Professor Strang has published over 400 scientific papers in the addiction field and is one of only five 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.  His published edited books include co-editorship of ‘Heroin Addiction and Drug Policy: the British System’, ‘Methadone Matters: evolving community methadone treatment of opiate addiction'; and 'Drug Policy and the Public Good'.