Heroin Substitute Supervision Saves Lives, UK

Researchers have identified that supervision of methadone prescribing has substantially reduced deaths among users of the heroin substitute, at a time of growing heroin addiction problems and expanded methadone prescribing.



It has long been known that treatment with methadone reduces deaths among heroin addicts but there have been historic concerns about misuse and overdoses of methadone itself.



"We've been able to identify, for the first time, dramatically reduced mortality from deaths involving methadone, despite the recognised high risk of early death in this population," says Professor John Strang of the National Addiction Centre, jointly run by SLaM and the Institute of Psychiatry, King's College London..



"We are now achieving the positive benefits from this treatment with much lower risk of the negative complications".



"And the key determinant is the introduction of supervised administration of methadone in controlled doses. That prevents stockpiling, which reduces the opportunity for overdosing or passing on methadone to others who are equally at risk."



The findings in more detail:



The research found that changes in methadone prescribing practice in the 1990s, particularly the introduction of daily supervision of doses in the early stages of treatment, have been highly effective in making methadone treatment safer - achieving a fourfold reduction in deaths involving methadone across England and Scotland. It also suggests that other changes to treatment could further reduce over-dosing from 'opioids' - heroin and synthetic substitutes. Opioids are implicated in over three-quarters of all illicit drug related deaths in the UK.



The findings are published online in the British Medical Journal on Friday 17 September. The research team developed a new measurement tool 'OD4' which measures deaths per million daily doses of methadone prescribed in a year. The study covering 1993 to 2008 looked at the effects of the introduction of supervised dosing of methadone from in Scotland (1995-2000) and England (1999-2005) and found methadone deaths per million doses declined at the same time as there was an 18-fold increase in methadone prescribing in Scotland, and a 7-fold increase in England.



The National Addiction Centre (NAC), is jointly run by the Institute of Psychiatry, King's College London and South London and Maudsley NHS Foundation Trust - both part of King's Health Partners Academic Health Sciences Centre.



To read the full article visit the British Medical Journal website.



Notes


- SLaM's Supervised Injecting Clinic provides intensive treatment for people with a severe heroin addiction, where previous orthodox drug treatment has failed. People are prescribed injectable heroin (diamorphine) or methadone, which is administered at the clinic under supervision.


- For more information on SLaM's Supervised Injecting Clinic visit here.


- Professor John Strang has been a Consultant Psychiatrist in addictions treatment for over 30 years at SLaM. He 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 heroin addiction and he is also Head of the Addictions Department at King's College London.


- For more information on Professor John Strang visit here.


- South London and Maudsley NHS Foundation Trust (SLaM) provides national services to people across the UK. It also provides mental health and substance misuse services for people living in the London Boroughs of Croydon, Lambeth, Southwark and Lewisham. In addition, the Trust provides substance misuse services for people in the London Boroughs of Bexley, Greenwich and Bromley.


Source:

South London and Maudsley NHS Foundation Trust