Contents
Chapter 1: Introduction 9

Chapter 2: Essential elements of treatment provision 15
2.1 Key points 15
2.2 Assessment, planning care and treatment 15
2.3 Delivery of treatment 27
2.4 Drug testing 28
2.5 General health assessment at presentation and in treatment 31
2.6 Effective communication with primary and secondary care services 35
2.7 Organisational factors for effective drug treatment 35
2.8 Intimate partner violence and domestic abuse 43
2.9 Planning and contracting or commissioning services 44

Chapter 3: Psychosocial components of treatment 47
3.1 Key points 47
3.2 Introduction 47
3.3 Core elements underpinning effective delivery 51
3.4 Making psychosocial interventions effective 52
3.5 Interventions focused on social network and family, friends and carers 56
3.6 Medication and psychosocial interventions 57
3.7 Delivering psychosocial interventions 58
3.8 Resources and further reading 81
3.9 References 81

Chapter 4: Pharmacological interventions 83
4.1 Key points 83
4.2 Prescribing 84
4.3 Choosing an appropriate opioid substitute 88
4.4 Induction onto methadone and buprenorphine substitution treatment 90
4.5 Supervised consumption 101
4.6 Assessing and responding to progress and failure to benefit 104
4.7 Opioid maintenance prescribing 110
4.8 Opioid detoxification 115
4.9 Naltrexone for relapse prevention 118
4.10 Pharmacological management of dependence on other drugs 119
4.11 Resources and further reading 124
4.12 References 125


Chapter 5: Criminal justice system 127
5.1 Key points 127
5.2 Introduction 128
5.3 Criminal justice systems in the community 130
5.4 Prisons and other secure environments 133
5.5 References 160

Chapter 6: Health considerations 163
6.1 Key points 163
6.2 Blood-borne viruses and other infections 163
6.3 Preventing drug-related deaths 174
6.4 Naloxone 178
6.5 Alcohol in drug treatment 183
6.6 Smoking and respiratory function 187
6.7 Oral health 190
6.8 References 194

Chapter 7: Specific treatment situations and populations 197
7.1 General key points 197
7.2 Pain management 197
7.3 Dependence on prescribed and over-the-counter opioids 205
7.4 Misuse of or dependence on gabapentinoids 208
7.5 Hospitalisation 209
7.6 Pregnancy and neonatal care 220
7.7 New psychoactive substances and club drugs 225
7.8 Image and performance enhancing drugs 229
7.9 Coexisting problems with mental health and substance use 231
7.10 Young people 240
7.11 Older people 247
7.12 References 252

Annexes 255
A1: Working group members and other contributors 257
A2: Governance 263
A3: Marketing authorisations 271
A4: Writing prescriptions 277
A5: Interactions 293
A6: Travelling abroad with controlled drugs 303
A7: Drugs and driving 305
A8: Glossary 311