Methadone matters : evolving community methadone treatment of opiate addiction

298 Pages·1998·2.63 MB·English

by  Gillian Tober

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Methadone Matters:
Evolving Community Methadone
Treatment of Opiate Addiction
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Methadone Matters:
Evolving Community
Methadone Treatment
of Opiate Addiction
Edited by
Gillian Tober
Head of Training
and Deputy Clinical Director
Leeds Addiction Unit
Leeds, UK
John Strang
Director, National Addiction Centre
Institute of Psychiatry and
South London and Maudsley NHS Trust
London, UK
CRC Press
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Contents
Editors vii
Contributors ix
Acknowledgements xiv
Abbreviations used xv
Section A: Introduction, background and
scope
1 Methadone: panacea or poison? 3
John Strang and Gillian Tober
2 The history of methadone and methadone 13
prescribing
Andrew Preston and Gerald Bennett
3 Methadone prescribing in the United Kingdom: what 21
can we learn from community pharmacy surveys?
Janie Sheridan
Section B: Aspects of clinical practice and
variations
4 Negotiating a script: the dynamics of staff/client 33
relationships
Alan Quirk, Robert Lilly, Tim Rhodes and Gerry Stimson
5 Linking psychology and pharmacology 45
Duncan Raistrick
6 Assessment and outcome monitoring 55
John Marsden, Michael Gossop and Duncan Stewart
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7 Plasma methadone monitoring: an aid to dose 67
assessment, monitoring compliance and exploration
of drug interactions
Kim Wolff
8 Withdrawal from methadone and methadone for 79
withdrawal
Nicholas Seivewright and Olawale Lagundoye
Section C: The special case of injectables
9 Injectable methadone: a peculiar British practice 91
John Strang and Janie Sheridan
10 Prescribing injectable methadone: to whom and 107
for what purpose?
Louise Sell
11 The supervised injecting clinic – a drug clinic’s 119
experience of supervising the intravenous self-
administration of prescribed methadone
Mike Cummins
Section D: The risks
12 Dependence on methadone: the danger lurking 131
behind the prescription
Gillian Tober
13 ‘Using on top’ and the problems it brings: 141
additional drug use by methadone treatment
patients
David Best and Gayle Ridge
14 Methadone and opioid-related deaths: changing 155
prevalence over time
Michael Farrell and Wayne Hall
15 The play, the plot and the players: the illicit market 167
in methadone
Jane Fountain and John Strang
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Section E: Service delivery
16 A primary care based specialist service 179
Susanna Lawrence
17 A central assessment service with widely 189
disseminated delivery in primary care
Fiona Watson, Linda Mays and Judy Bury
18 A centrally co-ordinated city strategic approach 199
Richard Watson, Jane Jay and Laurence Gruer
19 Supervised consumption of methadone in a 211
community pharmacy
Kay Roberts
Section F: Special cases
20 A methadone programme for substance-misusing 225
pregnant women
Ann Walker and James Walker
21 Methadone use in young people 235
Eilish Gilvarry, Jim McCambridge and John Witton
Section G: Methadone studies
22 Methadone treatment: outcomes and variation in 249
treatment response within NTORS
Duncan Stewart, Michael Gossop and John Marsden
23 Rapid benefit, but what thereafter? The rush and 259
trickle of benefit from methadone treatment
Emily Finch
24 Methadone maintenance and reduction treatments: 271
the need for clarity of goals and procedures
Michael Gossop, John Marsden and Duncan Stewart
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Section H: In conclusion
25 Methadone: achieving the balance 285
Gillian Tober and John Strang
Index 293
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Editors
Dr Gillian Tober is Deputy Clinical Director and Head of Training at the Leeds
Addiction Unit, and Associate Lecturer at the University of Leeds. She was
Principal Investigator for Training in the United Kingdom Alcohol Treatment
Trial. Her research is in the process of treatment delivery, the effectiveness of
addiction treatment, the nature and measurement of substance dependence.
Her clinical work includes development of and supervision in the use of
treatment manuals.
Professor John Strang is Director of the National Addiction Centre, leading
the clinical developments in addiction services at the South London and
Maudsley NHS Trust, whilst also directing the addiction research and
training work within the Institute of Psychiatry. His involvement with the
Department of Health has covered the period of the introduction of harm
reduction initiatives, and also the preparation of the ‘Orange Guidelines’; in
both, a more competent use of methadone treatment is charted.
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Contributors
Dr Gerald Bennett is Consultant Clinical Psychologist in Addictions for Dorset
Healthcare NHS Trust, Bournemouth, UK, and his publications focus on
interventions for addiction problems in the community.
Dr David Best is Senior Lecturer in the Addictions at the National Addiction
Centre/Institute of Psychiatry and Head of Research for the Police Complaints
Authority. He has an undergraduate degree in psychology and philosophy, a
Masters in Criminology and a PhD in explanation seeking and attributions related
to substance use. His main areas of research interest are around the relation-
ship between drugs and crime, developmental aspects of addiction careers
and lifestyle issues for drug users in contact with treatment services.
Dr Judy Bury is Primary Care Facilitator (HIV/Drugs) for NHS Lothian, based
in Edinburgh. She leads a team which offers support to GPs and other mem-
bers of the primary care team in caring for drug users and caring for people
with HIV infection. She previously worked in general practice and then in the
Community Drug Problem Service in Lothian and was involved in setting up
a scheme for supporting GP practices caring for drug users and for super-
vising methadone consumption in Lothian.
Mike Cummins has been working for the NHS since 1986 and specialized in
addiction treatment since 1993. Between 1997 and 2001 he was the spe-
cialist nurse who supervised, on a day-to-day basis, the on-site self-injection
clinic for methadone maintenance clients in the Lambeth and Southwark
boroughs of London. He is now Team Leader for a community drug service
in Bromley.
Dr Michael Farrell is Senior Lecturer and Consultant Psychiatrist at the
Maudsley Hospital and National Addiction Centre, Institute of Psychiatry,
Kings College London. He is responsible for a community based drug and
alcohol service as well as inpatient services. His research interests include
treatment evaluation, with a particular focus on the treatment of drug depen-
dence, and psychiatric co-morbidity. He has been a senior policy adviser to
the Department of Health in England. He has worked as a consultant with
the World Health Organization and is a member of the WHO Expert Advisory
Committee on Drug Dependence and Alcohol Problems.
Dr Emily Finch is Consultant Psychiatrist and Honorary Senior Lecturer at the
National Addiction Centre and the South London and Maudsley NHS Trust.
She runs the methadone maintenance clinic at the Maudsley, the community
drug services for Croydon and a drug treatment and testing order programme.
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x
Her research interests include the outcome of treatment for opiate misusers,
drug using parents and coercive treatment in the criminal justice system.
Dr Jane Fountain is Principal Lecturer (Research) at the Ethnicity and Health
Unit, University of Central Lancashire, and has been researching aspects of
drug use for twelve years. She previously worked as a researcher at the
National Addiction Centre and is involved in qualitative research projects on
drug use for the European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) and the Council of Europe’s Pompidou Group.
Dr Eilish Gilvarry is Lead Clinician for the Addiction Services in Newcastle
upon Tyne and Co-director of the Centre for Alcohol and Drug Studies. She
has published widely, particularly in the field of youth substance abuse, and
leads a review of the Health Advisory Service Report on this subject.
Professor Michael Gossop is Head of Research in the Addictions Directorate
at the Maudsley Hospital in London, and a leading researcher in the National
Addiction Centre at the London University Institute of Psychiatry. He is the
Director of NTORS, the National Treatment Outcome Research Study. He is
the founding Editor of Addiction Abstracts, and his publications include more
than 300 works. These include 6 books. Living with Drugs first appeared in
1982 and has been continuously in print since that time; it has been pub-
lished in five editions.
Dr Laurence Gruer is Consultant in Public Health Medicine. He has played a
major role in planning and building services for drug users in Glasgow since
1988. He was responsible for setting up the Greater Glasgow Drug Misuse
Clinic Scheme and the Glasgow Drug Problem Service in 1994 and man-
aged the Scheme for its first seven years. He has been a member of the UK
Advisory Council on the Misuse of Drugs since 1996.
Professor Wayne Hall is Professorial Research Fellow and Director of the Office
of Public Policy and Ethics, Institute for Molecular Bioscience, University of
Queensland. He was formerly Executive Director of the National Drug and
Alcohol Research Centre and Professor of Drug and Alcohol Studies at the
University of New South Wales. His past research interests included: the
epidemiology of drug and alcohol use, the effectiveness of drug treatment, and
the health effects of amphetamine, cannabis and heroin use. He is Australasian
Regional Editor of Addiction (since May 1999) and has been an Adviser to the
World Health Organization and a Member of the WHO Expert Advisory Panel
on Drug Dependence and Alcohol Problems (since May 1996).
Dr Jane Jay has been Clinical Director of the Glasgow Drug Problem Service
since 1999. Before that she was a hospital physician. Her main research
interest is drug deaths.
Dr Olawale Lagundoye is Consultant Psychiatrist in Substance Misuse at the
Community Health Sheffield NHS Trust. He qualified from medical school and