Home > Effectiveness Bank Bulletin. [Heroin prescribing]

Drug and Alcohol Findings. (2012) Effectiveness Bank Bulletin. [Heroin prescribing]. Drug and Alcohol Findings, 15 June 2012,

PDF (Why prescribe heroin?) - Supplemental Material
PDF (Not treatment, but humane and medically advisable: The Rolleston legacy) - Supplemental Material

External website: http://findings.org.uk/docs/bulletins/Bull_15_06_1...

Heroin prescribing revamped and reassessed
Heroin prescribing has retreated in Britain from the mainstay of opiate addiction treatment available from any GP to a niche option for a few hundred patients treated by psychiatric specialists. Withering in its UK homeland, the treatment was reborn in continental Europe, but transformed by a different inheritance in to a tightly controlled option for failed methadone patients, who had to take their drugs at the clinic under medical supervision and accompanied by intensive psychosocial therapy. The first entry in the bulletin largely reflects the results of this transformation in the form of an update of a Cochrane synthesis of the research. Via continental Europe, this new way of working came to Britain, and was tested in the RIOTT trial.

The next two entries complement its main results with data on the impact on the local community of the clinic in London, confounding fears that addicts attending twice a day to take prescribed heroin was a recipe for drug-related disorder and nuisance. Finally, from the days of the Drug and Alcohol Findings magazine, we take this opportunity to remind readers of the searching review we conducted of the evidence, and of the fascinating origins of the British model of addiction treatment featuring indefinite heroin prescribing, formalised in the wake of the First World War.

Heroin maintenance for chronic heroin-dependent individuals.
Ferri M., Davoli M., Perucci C.A. Cochrane Database of Systematic Reviews: 2011, Issue 12, Art. No. CD003410.
Update of the first authoritative review to combine results from all trials to date of long-term heroin prescribing for the management of heroin addiction finds important advantages for seemingly intractable patients previously failed by methadone, including reduced illegal drug use.

The community impact of RIOTT, a medically supervised injectable maintenance clinic in south London.
Miller P., McKenzie S., Lintzeris N. et al. Mental Health and Substance Use: Dual Diagnosis: 2010, 3(3), p. 248–259.
Addicts attending a clinic twice a day to take prescribed heroin seems like a recipe for an unwelcome increase in local drug-related disorder and nuisance, but given (as there usually will be) small numbers, experience in London was that not much changed.

Investigating the effect on public behaviour of patients of a medically supervised injectable maintenance clinic.
Miller P., McKenzie S., Walker J. et al. Drugs and Alcohol Today: 2011, 11(4) , p. 204–209.
Addicts attending a clinic twice a day to take prescribed heroin seems like a recipe for an unwelcome increase in local drug-related disorder and nuisance, but in London the effect was to remove rather than add people to the troubling street-drinking population.

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