London Calling

Essay Competition

2012-01-27T21:30:00.002Z

The SMMGP is running an essay competition for undergraduate medical students and postgraduate registrars.
The challenge is to write an essay of no more than 1,200 words on any one of these topics:

Addiction to drugs is a brain disease and the real hope for future treatment lies only in medicine. Discuss.

Discuss your knowledge and experience of primary care drug and alcohol treatment; and reflect on what can be improved.

First prize is £200.00 in book vouchers and a free place at the RCGP primary care conference in Cardiff on 11 May 2012. Second prize is £100.00 in book vouchers and a free place at an SMMGP training event during 2012 or our next primary care development conference to be held during October 2012.

All entrants will automatically become members of SMMGP and receive our monthly clinical and policy updates, a copy of our popular clinical publication Network and be eligible for discounted delegate fees at the SMMGP annual primary care development conference. The winning entry will be published in a future edition of Network.

For more details see the SMMGP website www.smmgp.org.uk/html/news/essay-competition.php . The closing date is 5pm on Wednesday 29th February 2012.

A busy Christmas

2012-01-27T11:20:00.002Z

After having a hectic end to last year and Christmas, I am catching up with myself and will be e-mailing out to the PANN group soon about meetings for the coming year.
In the mean time there are a lot of other things going on.....

LJWG for Substance Misuse and Hep C conference

2011-11-25T23:23:00.000Z

It was good to see so many fimilar faces at the 2nd LJWG conference yesterday. It was a lively and stimulating meeting, with the audience contributing ideas as to how hepatitis C can be moved up the public health agenda.
The LWJG have published a consensus statement on the website - http://www.ljwg.org.uk - which raises a challenge to all those who work with substance users. There recommendations for drug services are:
• Every patient attending a drug service in London should be tested for blood borne viruses (BBVs) and, if negative, repeat tested every 6 months. A baseline target of 90% should be adopted in all drug services.
• Every patient attending a drug service in London should be vaccinated against hepatitis A and B. A baseline target of 90% uptake should be adopted in all drug services.
• Every hepatitis C RNA-positive patient should be referred to a specialist treatment service for assessment, and provided with support to attend if required.
• Every drug worker should have a clear basic knowledge of hepatitis C, (through completing the RCGP Certificate in the Detection, Diagnosis and Management of Hepatitis B and C in Primary Care, or an equivalent qualification).
• Consistent harm reduction advice and education should be provided through all services working with drug users, including all needle exchange services.
• Every local drug service centre should have a nominated person responsible for liaising with hepatitis treatment centres, prisons and primary care.
How does your service do?

SMU becomes SMAH

2011-11-21T11:36:00.003Z

The RCGP Substance Misuse Unit has changed its name to the RCGP Substance Misuse and Associated Health (SMAH)!

Dr Linda Harris, the Clinical Director of the SMAH writes;

"The name change takes into account the rapidly increasing portfolio of educational programmes that sit underneath its umbrella. Those GPs and primary care professionals working in the substance misuse field will be well aware of the impact of the introduction of the reforms detailed in the NHS and Public Health white papers, as well as the 2010 Drugs Strategy. The National Treatment Agency will be moving into Public Health England, and drug and alcohol treatment and other public health behaviour change areas will be brought together.
Over the past year my colleagues and I have been working on a new strategy that will see SMAH's educational programmes modularised. This will lead into a published programme of modules that will form a comprehensive portfolio, mapping to competencies and skills."

Now I will have to change all my paperwork..........

Ketamine use on the increase

2011-11-18T11:26:00.003Z

DrugScope’s 2011 Street Drug Trends Survey suggests more drug services are seeing people coming forward for help with the drug ketamine. The annual survey analyses feedback from 80 drug services, police forces, drug action teams and service user groups in 20 towns and cities across the UK to give a snapshot of current UK street drug trends. The 2010/11 British Crime Survey also showed increases in reported use of the drug among 16 to 24 year olds.
Ketamine was originally developed in the 1960s as an anaesthetic for battlefield surgery. Hospital patients reported disturbing visions as they regained consciousness after surgery restricting its use. It is still used in veterinary medicine. Illicit supplies appear to come mainly from India, China and the Far East.
Users may experience a ‘K-hole’ - a subjective state which might include out-of-body experiences, confusion, temporary memory loss and vivid hallucinations. Use of the drug can become compulsive, particularly when injected.

As the drug is an anaesthetic some users can injure themselves without realising while under its influence; its hallucinatory properties can also increase the risk of injury through risk-taking behaviour.The drug depresses the respiratory system and use in conjunction with alcohol is particularly risky.
For long term or dependent users, evidence is growing of the drug’s harmful impact on the urinary tract, with some dependent users experiencing extreme bladder problems.

For more details:

http://www.drugscope.org.uk/ourwork/pressoffice/pressreleases/Druglink-survey-2011

Amy Winehouse

2011-07-26T23:10:00.003+01:00

Like all our patients who die from drink or drugs, (and I am presuming that at this stage), what a sad loss of talent......

http://www.youtube.com/watch?v=5LTPRJqt2z4

And a song about crystal meth....

2011-07-23T17:12:00.001+01:00

http://www.youtube.com/watch?v=66dzbVjFQFA

Long acting amphetamines for amphetamine users?

2011-07-23T16:50:00.004+01:00

An Australian study has tested the impact of dexamphetamine, a long-acting form of amphetamine, as medication to help users who were dependent on methamphetamine. This is thought to be the first study of its kind.

In a double blind study of 49 participants, patients were randomly allocated to either a treatment group or a placebo group. Patients attended daily for supervised consumption, and all the patients were offered the same psychosocial support.

The most statistically significant result was greater retention among patients prescribed the active medication. Both groups showed an easing of their dependence from the start to the end of treatment which was continued in the active treatment group after the treatment finished. During treatment estimated consumption of methamphetamine fell in both groups, a drop largely sustained at the final follow-up. These results were broadly confirmed by testing hair samples.

One experienced a serious side effect in the active treatment group – high blood pressure requiring a dose reduction.

The results suggest that a maintenance programme of daily sustained-release amphetamine is both feasible and safe, and improves engagement.

With thanks to Drug and Alcohol Findings; for more details:

http://findings.org.uk/count/downloads/download.php?file=Longo_MC_2.txt

RCGP Certificate for the Management of Hepatitis B and C

2011-07-22T11:53:00.003+01:00

Details of the new RCGP Certificate in the 'Detection, Diagnosis and Management of Hepatitis B and C in Primary Care' have been announced.

The RCGP Certificate in the Detection, Diagnosis and Management of Hepatitis B and C in Primary Care is an educational package largely aimed at generalist clinicians such as GPs and nurses already working in primary care, and it provides a basic grounding in issues around hepatitis B and C. It will be particularly useful for GPs with a special interest in substance misuse, drugs workers and those involved in needle exchange and harm reduction services.

The certificate is in 3 parts:

The e-module is available to everyone for free at http://elearning.rcgp.org.uk/.

Part 1 - To obtain the Part 1 of the Certificate you will need to complete the e-module and then attend one of the RCGP accredited face-to-face training days, equivalent to six hours continuing professional development (CPD). The first National Events 2011 have just been announced:
Friday 9th September London

Friday 23rd September Birmingham

Thursday 24th November Manchester
Part 2 - Is a continuation of the existing certificate and will develop further knowledge and skills for primary care clinicians. This training will be delivered by primary and secondary care specialists and will be equivalent to 6 hours of continuing professional development (CPD). Part 2 is still under development and is planned to be rolled out in early 2012. To register your interest in Part 2 of the Certificate contact hepbandc@rcgp.org.uk .

You will need to register with the RCGP in order to book on-line or access the e-module:

https://integra.rcgp.org.uk/membersarea/custom/register_precheck.asp

For more details please contact the RCGP Substance Misuse Unit at hepbandc@rcgp.org.uk or:

Marianne Thompson
RCGP-SMU
1 Bow Churchyard
London
EC4M 9DQ

Does naltrexone work as maintenance therapy?

2011-07-11T11:48:00.002+01:00

Naltrexone is a an opioid 'antagonist', meaning that it blocks the effects of heroin. For this reason it has been considered a useful way of enabling users to avoid the temptation of taking opiate-type drugs after detoxification.

However a Cochrane review found that oral naltrexone led to no statistically significant differences in the primary retention/abstinence outcomes when compared to placebo, no medication or alternative medications. The biggest problem was the high proportion of drop outs.

A parallel Cochrane review of the newer implant and depot preparations also found insufficient evidence to evaluate their effectiveness.

For more details: http://findings.org.uk/count/downloads/download.php?file=Minozzi_S_1.txt

With thanks to Drug and Alcohol Findings.

Where's the evidence?

2011-06-20T16:25:00.003+01:00

There seemed to be a stream of media stories attacking methadone substitution therapy over the weekend. This is from the Independent:

http://www.independent.co.uk/life-style/health-and-families/health-news/failure-to-help-drug-addicts-is-costing-britain-16336bn-a-year-2299755.html

My question is where is there evidence? The evidence clearly shows that treatment works.

The home office study published last year (Drug Treatment Outcomes Research Study) found that "For every £1 spent, an estimated £2.50 was saved and drug treatment was overall found to be cost beneficial in 80 per cent of cases." This was compared to no treatment and included the savings made from reduced offending behaviour.

Secure Environment Training

2011-06-03T10:21:00.001+01:00

The RCGP will be holding two Certificate in the Management of Drug Misuse Part 1 -Secure Environment training days on Tuesday 20th September 2011 in Birmingham and Tuesday 27th September 2011 in London.
Each day will be able to accommodate 40 delegates but it will be on a first come-first served basis. The cost of these courses will be £250.

For more details look on the RCGP website:

www.rcgp.org.uk/substancemisuse

or contact Lorna Boothe - E-mail: lboothe@rcgp.org.uk Tel: 020 3188 7649

The world's most senseless war?

2011-06-02T19:07:00.002+01:00

Across the news today are calls to decriminalise the possession of drugs:

http://www.guardian.co.uk/society/2011/jun/02/drugs-drugspolicy

Next week the Global Commission on Drug Policy meets in New York to present its report and recommendations to the UN to end the war on drugs and move towards regulation. In support, Avaaz has launched an online petition to get 1 million signatures to be delivered to Ban Ki Moon along with Commission's findings.

If you would like to add your name to this petition go here:

http://www.avaaz.org/en/end_the_war_on_drugs/?cl=1081290944&v=9209

Youth Health Talk

2011-05-30T16:07:00.002+01:00

Youthhealthtalk.org has launched a new online resource about young people’s experiences of binge-drinking and taking drugs, designed to inform young people, their parents, teachers and health professionals.

The site features audio and video clips of detailed interviews with 33 young people in their teens and twenties from all walks of life. A range of topics are discussed including peer pressure, mental health, contact with health professionals, overcoming addiction, drugs and the law and choosing not to use drugs and alcohol.

www.youthhealthtalk.org/young_people_drugs_and_alcohol

Recovery - How to make the system work for you!

2011-05-16T11:49:00.002+01:00

The 6th SMMGP National Primary Care Development Conference will be on Thursday 13 October 2011 at the Burlington Hotel, Birmingham.
This conference is about embedding recovery in primary care drug and alcohol services. The programme includes:
Practical examples of the recovery system in action in primary care.
Forging links to self-help.
Workshops on payment by results, stigma, peer mentoring, welfare reform, engaging with GP consortia, health and wellbeing for people who use drugs and alcohol.
The journey ahead, including Public Health England; the inclusion of alcohol in the drug strategy.
All the details are available on the SMMGP website:

http://www.smmgp.org.uk/html/news/events.php#131011

17th National Conference

2011-05-16T11:46:00.002+01:00

ADVANCE WARINING!

Next years annual RCGP National Conference will be in Cardiff on 11th and 12th May 2012.

For details contact matt@healthcare-events.co.uk

Were you in Harrogate?

2011-05-16T11:32:00.002+01:00

Were you in Harrogate for the 16th annual RCGP National Conference on 12th and 13th May?
How did you find it?
I thought that this was one of the strongest annual conferences I have been to, with very good key speakers and very good special interest papers. I went to the paper presentations which were uniformally strong. And by popular demand there was a conference statement!
The statements and the papers will be posted on the SMMGP website in due course:

http://www.smmgp.org.uk/html/rcgpconference/rcgpreports.php

This year the conference finished strongly and did not just peter out.
However I did not see too many faces I recognised from London which was a pity.
If you were there, do you have any comments?

A new certificate in substance misuse

2011-05-09T11:33:00.002+01:00

The RCGP Substance Misuse and Associated Health Unit is launching a new certificate:

Harm Reduction, Health and Well Being for Substance Users.

The first face to face event for the certificate will be running in London on 26th May 2011. This certificate is aimed at those practitioners who are encountering substance misuse as part of their day to day work in health or social care. Particularly those not traditionally involved in providing services to this patient group, but it will also act as an important refresher for practitioners involved in shared care or specialist services and/or as an CPD update for Part 1 certificate holders

It is intended that by completing the certificate participants will be better able to apply techniques that will reduce the harm that substance misuse can do and promote the health and wellbeing of substance misusing patients, their families and the community.

Bookings can be made on-line at:

http://www.rcgp.org.uk/substance_misuse/harm_reduction_health_and_well.aspx

Or contact the programme co-ordinator Marianne Thompson:
Tel: 020 3188 7653
E-mail: marianne.thompson@rcgp.org.uk

Assessment and management of psychosis with coexisting substance misuse

2011-05-02T14:25:00.002+01:00

The BMJ have published a summary of the NICE guidance on the assessment and management of psychosis with coexisting substance misuse. This is well worth a read - but difficyult to think of a picture for!

http://www.bmj.com/content/342/bmj.d1351.full?sid=397cd28e-3ac2-4b12-ab9f-717122c4197f

National Institute for Health and Clinical Excellence. Psychosis with coexisting substance misuse: assessment and management in adults and young people. (Clinical guideline CG120.) 2011. http://guidance.nice.org.uk/CG120.

Certificate in Detection, Diagnosis and Management of Hepatitis B and C

2011-04-15T23:12:00.002+01:00

The RCGP in conjunction with SMMGP is holding a pilot day for the new Certificate in Detection, Diagnosis and Management of Hepatitis B and C in Primary Care. This is on 27th May in London.

Part 1 of the course will consist of a face-to-face training day together with an e-module and is targeted at GPs, practice nurses and other healthcare professionals.

If you would like to attend the pilot day then please email your expression of interest to hepbandc@rcgp.org.uk. It is not necessary to have expertise in Hepatitis B and C to attend the pilot.

New Opioid Prescribing Guidance

2011-03-21T15:20:00.003Z

The new "Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care" has been published by the RCGP and SMMGP. It is completely updated in line with NICE, Clinical Guidelines and the recovery agenda, and replaces the two seperate guidelines on methadone and buprenorphine.

http://www.smmgp.org.uk/download/guidance/guidance004.pdf

Drinking dangerously

2011-03-18T11:26:00.002Z

There are several articles in the February 26th edition of the BMJ about alcohol including a summary of the NICE guidance on the diagnosis, assessment and management of harmful drinking, a meta-analysis of the association of alcohol and cardiovascular disease showing that light drinkers (<1>

http://www.bmj.com/content/342/bmj.d700.full

Building links with employers

2011-01-23T16:27:00.002Z

London Drugs and Alcohol Network will be holding a free half day network event on building links with employers on 1st March at the Resource Centre in Holloway 12.30-4.30pm.

This event is open to all staff and volunteers from drug and alcohol or related services in London. The event will include presentations from treatment providers, policy leads and employers as well as personal testimonies from current or former service users.

To book a place or for further details please contact:

Esther Sample, Policy Officer, London Drug & Alcohol Network c/o DrugScope Prince Consort HouseSuite 204 (2nd Floor)109 - 111 Farringdon RoadLondon EC1R 3BWT.

020 7520 7566 or 020 7520 7565
Esthers.ldan@drugscope.org.uk
http://www.ldan.org.uk/

They have also produced a new report ‘Pathways to employment in London: A guide for drug and alcohol services’ which can be accessed at: https://web.nhs.net/owa/redir.aspx?C=cafa7511ab054d348088a720eecb88a2&URL=http%3a%2f%2fwww.drugscope.org.uk%2fResources%2fDrugscope%2fDocuments%2fPDF%2fPolicy%2femployment-report-revised.pdf

Alcohol tax and price affects morbidity and mortality

2011-01-16T18:16:00.002Z

A systematic review of 50 papers found a small but statistically significant but inverse relationship between the price or amount of tax on alcohol and mortality and morbidity. All the studies analysed found some inverse relationships and most were statistically significant.

Combined with another meta-analysis of 112 papers in 2009, the findings imply that doubling alcohol taxes would on average reduce alcohol-related mortality by 35%, traffic crash deaths by 11%, sexually transmitted diseases by 6%, violence by 2%, and crime by 1.2%.

In the UK, the total cost to the economy of alcohol-related death, illness, crime and other adverse impacts has been estimated at up to £25.1 billion a year. So raise taxes on alcohol and save money on alcohol related morbidity and mortality.

For the full paper see here http://ajph.aphapublications.org/cgi/content/abstract/100/11/2270 .

Thanks to Drug and Alcohol Findings for drawing my attention to this paper. If you wish to be alerted to new studies and reviews in the drug and alcohol field, you can sign up here:

http://findings.org.uk/index.php#signUp

PANN Meeting 11th November 2010 - The Recovery Agenda

2010-11-28T16:20:00.000Z

The meeting on Thursday 11th November discussed 'The Recovery Agenda'. Those who attended found it very interesting and there was a very good discussion. So my thanks to Alson Keating from the NTA for coming to speak.

The slides (including some which we not shown on the day) will be displayed on the the main RCGP website in the near future: http://www.rcgp.org.uk/professional_development/substance_misuse/pann/recent_meetings.aspx

One area which was discussed was the recording of information on the GP computer systems particularly the Treatment Outcome Profiles (TOPs). Alison is keen to hear about issues which clinicians have in recording substance msuse data. If you have any points you wish to raise please e-mail me.

Alcohol more harmful than crack?

2010-11-02T18:14:00.005Z

Members of the Independent Scientific Committee on Drugs (which was formed by David Nutt after he was sacked from the Advisory Council on the Misuse of Drugs), scored 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others.

The findings were widely reported in the press but showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals whereas alcohol, heroin, and crack cocaine were the most harmful to others.

Overall, alcohol was the most harmful drug (overall harm score 72 out of 100), with heroin (55) and crack cocaine (54) in second and third places.

I would not disagree with that!

Unfortunately I cannot find full access to the article but a summary and the reference is here:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61462-6/fulltext#

A fall in class A drug use?

2010-11-02T17:25:00.003Z

The NTA has been hard at work publishing a lot of data recently.

Their figures show a sharp drop for the first time in the numbers of drug users seeking treatment for addiction to cocaine and crack, in all age groups but is particularly among young adults aged 18-24. A study by Glasgow University, commissioned by the NTA, also found the numbers of heroin and crack addicts falling fastest among young adults.

The NTA report is published alongside independent research that estimates the number of heroin addicts in England has fallen by almost 11,000 in recent years. This fall in demand for heroin treatment among young adults aged 18-24 was noted last year and has continued this year.

This data is on the NTA website:

http://www.nta.nhs.uk/national-stats-2010.aspx

Forum for prison doctors

2010-10-04T23:16:00.002+01:00

One of the common complaints I come across when teaching on the part 2 certificate course is that prison doctors are often very isolated with a lack of clinical support and supervision. I encourage my group to try to build support networks but this can be difficult in prisons too.

However one of my candidates this year pointed me in the direction of the forums at doctors.net where he has set up a forum for prison doctors to discuss their clinical problems.

If you are interested then you will have to register with doctors.net but I hope that you will find some answers to your problems!

https://www.doctors.net.uk/Login/Login.aspx

There isn't a forum for prison on SMMGP because it is for general practice, although a variety of problems are raised there:

http://www.smmgp.org.uk/html/forums.php

If you know of any other suitable forums, please let me know.

12 myths about HIV/AIDS and people who use drugs

2010-10-03T14:02:00.002+01:00

Enough said.......

http://press.thelancet.com/drugshiv12myths.pdf

...except thanks to Chris Ford for drawing my notice to this article.

Cocaine Blues

2010-09-20T11:21:00.002+01:00

Bob Dylan's version of 'Cocaine Blues' takes us through some of the less pleasant aspects of cocaine use — hence the 'blues':

"Cocaine’s for horses and it’s not for men,

Doctor said it kill you, but he didn’t say when.

Cocaine all around my brain."

http://www.youtube.com/watch?v=_zCy2GMm42s

Stigmatisation and drug users

2010-09-20T10:36:00.002+01:00

Do we treat 'junkies', drug misusers, drug abusers, drug users or patients with a substance use disorder?

A report for the UK Drug Policy commision aims to summarise what the research evidence has to tell us about the stigmatisation of problem drug users.

This is a fascinating and challenging read, and includes suggestions as to how stigmatisation can be challenged, such as a campaign to stop the use of the word ‘junkie’ in the British press.

http://www.ukdpc.org.uk/resources/Stigma_Expert_Commentary_final.pdf

Impact of supervision of methadone consumption on deaths

2010-09-17T18:16:00.002+01:00

A retrospective study in the BMJ has found that annual OD4-methadone index (number of deaths with methadone implicated per million defined daily doses of methadone prescribed in that year) declined substantially between 1993 and 2008. The decrease in deaths was closely related to the introduction of supervised consumption of methadone, first in Scotland (1995-2000) and later in England (1999-2005). The decrease occurred over periods of substantial increases in prescribing of methadone (18-fold increase in defined daily doses per million population annually in Scotland and sevenfold increase in England).

The authors concluded that there was not another clear explanation to account for the reduction in methadone deaths except for the introduction of supervised consumption.

The full article is available here:

http://www.bmj.com/content/341/bmj.c4851.full

Survival and cessation in injecting drug users

2010-09-15T12:34:00.002+01:00

A prospective observational general practice study of nearly 800 patients in Edinburgh published in the BMJ has found that "for each additional year of opiate substitution treatment the hazard of death before long term cessation fell 13%" - long term treatment reduces the risk of death in patients who are injecting. The leading causes of death were HIV, drug overdose and liver disease, with drug over dose causing three quarters of the deaths in patients who had not stopped injecting. Patients who achieved long term cessation also had lower levels of morbidity.

The study also found that patients who were also on opioid substitution therapy also had an increased duration of injecting ( the time before cessation). Duration was increased by 11% for each year of treatment. This is what is seen in practice; treating patients gives patients stability which 'allows' them to continue using, but in less risky ways. For example, if you only use once a week your can fund your drugs through work or benefits and not have to do crime. To change this behaviour takes a lot of motivating.

I suspect that this increase in the duration of injecting will be used to promote 'recovery' and the limiting the length of prescribing. But if you ask the patients I am sure that they will choose to live longer than take a long term prescription.

The full article is here:

http://www.bmj.com/content/341/bmj.c3172.full

Ignorance is bliss!

2010-09-02T18:00:00.002+01:00

"80% of prisoners on methadone are being parked and forgotten about" - so say the Scottish Conservative, John Lamont. This is based on their research that "just 20% of prisoners who are being prescribed methadone are on a reducing dose."
Was it David Cameron who said in the election campaign that patients should not be parked on methadone? No the Scottish Conservatives are jumping on the bandwagon and expect our coalition government to follow on as they promote the recovery agenda.
It is a shame that they forget you can be a stable dose of treatment and have other forms of treatment to help with their substance misuse. Or that high doses of methadone help prevent patients from using and prevent harm. These patients are being treated, they are certainly not being forgotten about.
So what happens when you take prisoners off methadone. Do they stop using? No. Drugs are freely available in prison and continuing to prescribe opioid substitution therapy will continue to prevent harm.
http://www.scottishconservatives.com/news/news/607
I think this will be the same argument to come nationally as the coalition government sees it as a way to save money.

Have your say!

2010-08-24T19:05:00.002+01:00

The coalition government has issued a consultation paper about the future of drug strategy. It is comprehensive and does take a long time to complete, even though it does seem to invite yes/no answers at times. You don't have to complete it all though. Most of the answers are limited to 200 words when you sometimes want to write a 2,000 word essay.

Ultimately a lot of the answers seem to come down to money, and there does not seem to be any more money coming.

Don't be put off though - have your say.

http://www.homeoffice.gov.uk/publications/consultations/cons-drug-strategy-2010/

August - a quiet month

2010-08-24T17:44:00.004+01:00

August is always a bit quiet. So it is nice to see James Bell, who spoke to the PANN meeting about the opioid injecting clinics last year, livening up the debate about legalising drug.

http://www.guardian.co.uk/commentisfree/2010/aug/19/why-not-tax-my-drug-addicts

The title speaks for itself!

Methadone man and buprenorphine babe

2010-07-15T17:18:00.002+01:00

If you wonder whether we succeed in getting our harm minimisation message across, have a look at how things are being done across the 'pond'!

(With thanks to Chris Ford).

http://www.wheresthemethadone.org/

I predict a RIOTT

2010-07-07T22:56:00.003+01:00

In November last year, Dr James Bell came to PANN and talked to us about the ongoing injectable opioid trial which was being undertaken in the UK.

The findings of the trial have now been published in the Lancet:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60349-2/abstract

The authors found that 'treatment with supervised injectable heroin leads to significantly and substantially lower use of street heroin than supervised injectable methadone or optimised oral methadone. They also found that of patients who were injecting heroin daily 'nearly half were close to abstinent from street heroin' and that 'about a fifth of patients previously not doing well on oral methadone also greatly improved on the study's optimised oral methadone programme'.

The authors concluded that 'the results of this trial suggest that supervised injectable heroin should now be provided, with close monitoring, for carefully selected, chronic heroin addicts in Britain previously unresponsive to mainstream treatments'.

For a good critical analysis of this paper, have a look at Drug and Alcohol Findings:

http://findings.org.uk/count/downloads/download.php?file=Strang_J_21.txt

Ministers declare war on Britain's tranquilliser crisis

2010-07-06T09:02:00.002+01:00

Ahead of the PANN meeting discussing benzodiazepines on 6th July, The Independent on Sunday published an article with the headline; 'Ministers declare war on Britain's tranquilliser crisis'.

Despite the headline, the content of the article was less inflammatory;

"A Department of Health source said last night that the junior public health minister, Anne Milton, was "deeply sympathetic" to the plight of "involuntary tranquilliser addicts". "This is something ministers have been concerned about for years. It is clear that too many of these drugs are being prescribed and that there are alternative treatments," the source said."

While I doubt that "millions could be shaved off the NHS budget" (because the NHS will have to pay more for 'talking therapies'), it is good to see that Ministers are supporting the work of the RCGP SMU and PANN.

For the full article see:

http://www.independent.co.uk/news/uk/politics/ministers-declare-war-on-britains-tranquilliser-crisis-2017933.html

Prescription of heroin for the management of heroin dependence

2010-07-01T17:10:00.002+01:00

Nick Lintzeris (who spoke to the PANN meeting a couple of years ago) has published a review of the evidence for prescribing of injectable or smokable heroin to heroin addicts on a maintenance basis in CNS drugs.
The review concludes that retention in treatment appears to be broadly comparable in heroin and methadone only programmes, but compared to oral methadone, heroin-based treatment further reduces illicit heroin use, though in both treatments this is markedly reduced.

However heroin treatment is considerably more expensive and the savings made are in the criminal justice system rather than health care. The review suggests that heroin treatment should not be a front-line treatment, but reserved for patients who do not respond well to conventional substitute prescribing. It goes on to suggest how 'failure to respond' may be defined.

The review also highlights safety concerns with heroin treatment, including long-term injecting and a high incidence of seizures and overdoses immediately after injection, raising concerns about the long-term effects of recurrent heroin-induced shortage of oxygen.

Unfortunately the review does not include the results of the RIOTT trial in the UK (which was the focus of a recent PANN meeting).

My thanks to Drug and Alcohol Findings for highlighting this paper. The full paper is accessible via Athens but the summary can be found here:

http://findings.org.uk/count/downloads/download.php?file=Lintzeris_N_10.txt

Injecting drug use in Europe

2010-06-25T23:01:00.003+01:00

Have you ever wondered how the UK compares to the rest of Europe? While this report from the European Monitoring Centre for Drugs and Drugs Addiction on the trends in injecting is very interesting, it also frustrating as your want to know why there are differences between countries. For example, why does have Malta have such a high percentage of injecting drug users on entering treatment programmes?

Worth a look:

http://www.emcdda.europa.eu/attachements.cfm/att_108590_EN_EMCDDA_SI10_injecting.pdf

A small island

2010-06-08T17:17:00.002+01:00

If you wonder what goes on in the substance misuse world outside of this island, then there is an international network is for medical doctors to share expertise and good practice - IDHDP.

International Doctors for Healthy Drug Policies' purpose is to increase the participation of medical doctors in drug policy reform. There is a gap between evidence based practice and drug policy in many countries and IDHDP aims to lobby internationally to influence changes in drug policy to promote harm reduction and create healthy drug policies.

IDHDP also offers support to doctors in their home countries or regions by having core objectives/position statements, which promote harm reduction and healthy drug policies.

You can join IDHDP for free. If you would like more details have a look at the link on the SMMGP website:

http://www.smmgp.org.uk/html/idhdp.php

Minimum unit pricing for alcohol?

2010-06-02T13:49:00.002+01:00

In the news today has been a lot about unit pricing for alcohol. This has been supported by the the Nice public health guidance PH24, 'Alcohol use disorders; preventing harmful drinking'.

There is some interesting advice in this guidance which also suggests that GPs should be screening for alcohol use with the AUDIT questionnaire. It is certainly worth a look:

http://guidance.nice.org.uk/PH24/QuickRefGuide/pdf/English

The response from the Government was dissappointing with the Health Secretary Andrew Lansley apparently saying that he agreed with NICE on the urgency of the problem, but that it was not clear that a minimum price "is the best way to impact price in order to impact demand".

Didn't they have the same sentiments that about cigarette advertising? This looks like it will be a long fight......

The Coalition: our programme for government?

2010-05-21T21:40:00.002+01:00

The government's programme for the next five years has been laid out today. There are a number of commitments to drug policy, including:

temporary bans on new ‘legal highs’ while health issues are considered by independent experts;

a commitment to receive the full advice from the Advisory Council on the Misuse of Drugs on a substance’s harms;

the creation of an “ambitious strategy for public health” including health inequalities;

an investigation into a new approach to helping families with multiple problems;

and n exploration “alternative forms of secure, treatment-based accommodation for mentally ill and drugs offenders”.

Distinctly underwhelming, but perhaps that is just as well as there is nothing here about stopping patients being 'parked' on methadone which was the pre-election talk of the Conservative Party.

For more look here:

http://www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf

Why are so many doctors addicted to drink or drugs?

2010-05-13T16:41:00.002+01:00

The DS Daily also alerted me to this story; 'Special Investigation: Why ARE so many doctors addicted to drink or drugs?' But it was written it such a 'Mills and Boon' style, I couldn't be bothered to read it.
It referred to a home office study into doctors drug and alcohol use but did not given the details of the study, which may have been more interesting to read. If you know what the study was, could you let me know please.
You might have guessed the article was in the 'Daily Liam'.

The Road to Recovery

2010-05-13T16:18:00.003+01:00

A clear worry at the RCGP Glasgow conference was whether 'recovery' was going to become synonym for enforced abstinence.

There is a good article from published in the Guardian by Simon Antrobus, the chief executive of Addaction, about 'The Road to Recovery', emphasising that it is a long and rocky road and patients need long-term support.

http://www.guardianpublic.co.uk/addaction-comment-addiction (Sorry I do not know how long this article will remain posted.)

It is worth a read - let's hope our new Prime Minister has read it, before he 'parks' his agenda.

(Thanks to DS Daily for the alert - http://www.dsdaily.org.uk/.)

RCGP Alcohol Certificate

2010-04-30T16:50:00.000+01:00

The RCGP certificate in the management of alcohol problems in primary care is up and running.

The RCGP has developed this Certificate in response to increasing demand for education in the treatment of alcohol misuse. It is aimed at GPs and other healthcare professionals working in primary care.

In common with the successful certificate in the management of drug misuse, part 1, the certificate in the management of alcohol misuse is in two parts; the Department of Health Alcohol Identification and Brief Advice e-learning course

http://www.alcohollearningcentre.org.uk/eLearning/IBA/

and a one-day face-to-face event.

The next face-to-face event in London is on Friday 24th September 2010. To down load a booking form go to the main RCGP website:

http://www.rcgp.org.uk/practising_as_a_gp/substance_misuse/alcohol_certificate.aspx

Narcotics Anonymous

2010-04-26T22:31:00.003+01:00

One of the highlights of the RCGP 15th Annual Conference for me was attending an open meeting of NA.

To my shame I had never actually been to a meeting before, but an open meeting was held at the conference (at short notice I believe,) so I went (and missed lunch). It was very intense and powerful!

So my thanks to all those members who were prepared to give their testimonies to a large group of strangers. I was moved.

I hope that it will become a regular future of the conference, to allow others to glimpse at what happens at meetings.

NA do hold open meetings across the country. for more information do check their website:

http://www.ukna.org/meetings/

Reefer Man

2010-04-10T17:52:00.002+01:00

While considering the effects of cannabis - some music. "Have you ever met that funny, funny reefer man?" was the question posed in this piecefrom 1932, recorded by Cab Calloway and many others:

http://www.youtube.com/watch?v=D44pyeEvhcQ

Alternatively you could try "Pass the Dutchie" by Musical Youth from 1982 which went to number one, I seem to remember, before it was realised it was about cannabis:

http://www.youtube.com/watch?v=dFtLONl4cNc

These seem a bit less innocent when you read the clinical review in the BMJ!

Cannabis use disorders in primary care

2010-04-10T17:35:00.003+01:00

This weeks British Medical Journal (10th April 2010) contains a very good clinical review of the assessment and management of cannabis use disorders in primary care; BMJ.2010; 340: c1571.

Written by our own Chris Ford together with Adam Winstock and John Witton, it is well worth reading.

I will see if Chris can provide some copies for the next PANN meeting!

Legal Highs

2010-04-10T17:09:00.004+01:00

I am waiting for the presentation by Dr Paolo Deluca to be added to the main RCGP site. However if you wish to replay the video clips Paolo showed please click the links below:

Spice - http://www.youtube.com/watch?v=njEoINydfk8

Salvia - http://www.youtube.com/watch?v=jvnmNLXukpI (you need to sign in to see this clip)

Beware these clips contain strong language and are shocking.

The advert for 'plant food' has now been removed from youtube. However as Paolo said, there are plenty of other clips to look at if you surf the web.

If you want further information about legal highs then loook at the psychonaut web mapping project, but remember you will have to register.

http://www.psychonautproject.eu/

Wanted - New Regional Lead for the South East

2010-03-11T18:43:00.000Z

Unfortunately the RCGP Substance Misuse Unit was unable to appoint a new regional lead for the South East Region. The post remains vacant and the SMU are still looking for a suitable candidate.

The regional leads act as a point of contact in the provision of information, support and liaison for practitioners involved in or wishing to become involved in the care of drug users. They also provide signposting towards appropriate training schemes, support network, communication with National Expert Advisory Group, SMMGP NTA and other stakeholder groups, liaison with DATs, NTA Regional Leads, NTA, RCGP and GPs and support to certificate tutors.

If you are a dynamic, forward-thinking GP with experience in the field of substance misuse who is able to commit energy and innovation to direct, influence and contribute to the development of the drugs training programme at regional level, the SMU would like to hear from you. Leadership, communication and liaison skills are vital and an understanding of the wider political context of the substance misuse and governance fields is also essential.

This is an Honorary Contract, and there is a honorarium of £400 for attending the meetings plus standard class travel costs. The position will be offered for one year in the first instance though further funding is being sought to extend this.

If you are interested please contact the SMU, Suite 314, Frazer House, 32 – 38 Leman Street, London E1 or e-mail me.

More Music - The Stranglers

2010-02-03T21:23:00.004Z

Golden brown texture like sun

Lays me down with my mind she runs

Throughout the night

No need to fight

Never a frown with golden brown

The hardcore punk band, The Stranglers were thought to have gone 'mainstream' with the release of Golden Brown, until you listen to the words.

http://www.youtube.com/watch?v=d7R7q1lSZfs

Drug treatment saves money

2010-02-03T21:01:00.004Z

The home office has published a called Drug Treatment Outcomes Research Study (DTORS). This is an outcomes survey of treatment seekers over a 13 month period, a qualitative assessment of drug treatment and an economic analysis of the costs and benefits associated with drug treatment.

I must admit that I was largely underwhelmed by its findings except that
"For every £1 spent, an estimated £2.50 was saved and drug treatment was overall found to be cost beneficial in 80 per cent of cases." This was compared to no treatment and included the savings made from reduced offending behaviour.

To access a summary of the research, click the link:

http://www.homeoffice.gov.uk/rds/pdfs09/horr23.pdf

Future PANN meetings

2009-12-08T18:09:00.004Z

PANN is our forum for practitioners working in the field of primary care drug treatment. GPs, patients, shared care workers, commissioners, pharmacists and key workers are all invited to attend.

You will be pleased to know that the dates of the meetings for 2010 have been set for the afternoons of:
Tuesday July 6th 2010

Thursday November 11th 2010

As usual these will be at the Royal College of General Practitioners, 14 Princes Gate, Hyde Park, London, SW7 1PU (although the venue of the November meeting may well be changed).

If you know of anyone who has done either part 1 or part 2 of the Certificate, (or works with substance misusers in primary care,) and may benefit from being part of this network, please let me know their name and address, or e-mail address, so I can write to them. Newcomers are always welcome!

If you have any ideas or suggestions for future meetings, please let me know.

Falling purity 'accelerates trend' in polydrug use

2009-12-08T17:56:00.002Z

A downward trend in the quality of illegal drugs on the UKs street drug market could be driving changes in patterns of drug use, with users increasingly interchanging or combining a range of low quality drugs, according to DrugScope s 2009 Street Drug Trends Survey.

This year s findings show a fall in the reported quality of illegal drugs available in most areas over the last year. Seventeen out of twenty areas reported a drop in the quality of powder and crack cocaine, echoing a growing body of evidence showing declining cocaine purities. In one area, police reported seizing cocaine powder with purity levels as low as 2%.

The survey found that the drop in the quality of drugs could be accelerating a longer term trend towards poly drug use taking a variety of different substances in combination or at different times as users look to top up on low quality drugs or experiment with alternatives.

The 2009 survey also recorded national averages for the prices of individual street drugs. Most heroin was being sold by the bag and most crack cocaine was being sold by the rock. In 2009, the average bag of heroin weighed 0.15g and the average cost was £10. The average
rock of crack cocaine weighed 0.15g and the average cost was £10. There was no significant change from the 2006, 2007 and 2008 figures.

For more details, look on the Drugscope website:

http://www.drugscope.org.uk/ourwork/pressoffice/pressreleases/Street_drug_trends_2009.htm

Previous PANN meetings

2009-09-12T18:06:00.005+01:00

The PANN pages on the RCGP website have now been updated and the recent meetings have been added.

‘Why are drugs in London different?’ held on 11th November 2008.

'The elephant in the room' - screening for alcohol misuse and brief interventions for alcohol misusers - held on 14th July 2009.

To access them use this link: http://www.rcgp.org.uk/practising_as_a_gp/substance_misuse/pann/recent_meetings.aspx

If you wish to access the achieved summaries of previous meetings, please contact me.

My thanks to the RCGP.

Engaging the Community in Lambeth

2009-08-06T23:02:00.003+01:00

From Black Poppy in Lambeth

"Black Poppy's Engaging the Community project is an innovative and free project available for local community groups in Lambeth. It aims to empower local groups and individuals to find support to the problems they experience from drug use in their communities.

If you need to provide others in your community with support, advice or information about drug problems, but feel uninformed or overwhelmed, then perhaps we can help.

What do we do? If your neighbourhood, faith or support group would like to know about the types of services that are available to members of your community who have drug or alcohol problems, then members from Black Poppy can visit. We can discuss informally about local services and how they can help, provide you information packs, leave you with a direct phone number to advise you, and we can bring refreshments along as well! All without you having to leave your community centre!

Please ring Erin O'Mara on 0207 622 7770 or email blackpoppy@btconnect.com . Please feel free to give us a ring for more information."

'Focus on drug harms not just drug'

2009-08-03T20:59:00.003+01:00

"Absurd, dangerous, plain wrong. These mixed messages on drink and drugs are the road to social ruin." dailymail.co.uk

"Why it’s time to end the war on drugs" FT.com

"And why not legalise drug dealing and prostitution while you're at it?" Telegraph.co.uk

"The Big Question: Should police take a new approach to drug crime by relocating dealers?" Independent.co.uk

The UK Drug Policy Commission has stirred up a hornet's nest! Everyone will have their own views so rather than give you mine, read the original report (published on 30th July 2009):

http://www.ukdpc.org.uk/index.shtml

RCGP Certificate in the Management of Drug Misuse – Part One Courses

2009-07-17T23:24:00.000+01:00

Part One to the RCGP Certificate in the Management of Drug Misuse is ideal for GPs working at a generalist level, as part of a shared care scheme and for those intending to provide treatment to drug users as part of a locally or nationally enhanced service.

The Part One course is now a multi-disciplinary, so pharmacists, nurses, drug workers and other healthcare professionals can complete the certificate. The cost for the day is £250. The next two courses are:

Tuesday 29 September 2009
Tuesday 17 November 2009
11 January 2010
15 March 2010

These are all at RCGP, 14 Princes Gate, Hyde Park,London, SW7 1PU

Find out more at www.rcgp.org.uk/substancemisuse.

Or contact Lorna Boothe, RCGP SMU, Suite 314, Frazer House, 32-38 Leman Street, London, E1 8EW. E-mail: lboothe@rcgp.org.uk Tel: 0207 173 6093. Fax: 0207 173 6089.

Mother's little helpers

2009-07-04T17:03:00.002+01:00

At the RCGP part two certificate course in substance misuse, we were discussing the prescribing of benzodiazepines and one of the group remindered me of the Rolling Stone's classic song.

http://www.youtube.com/watch?v=EL_ygXeLbdU&feature=related

Mick Jagger looks incredible young!

Managing Hepatitis C

2009-07-04T16:32:00.002+01:00

For up to date information on how to manage hepatitis C, have a look at the clinical review in June 26th 2009 issue of the BMJ:

http://www.bmj.com/cgi/content/extract/338/jun26_1/b2366

Unfortunately you have to be a member to view it online.

However the RCGP booklet 'Guidnace for prevention, testing, treatment and management of Hepatitis C in Primary Care' is free and is also pretty damn good!

http://www.rcgp.org.uk/pdf/hep%20C%20guidance%20%20%202008.pdf

The effectiveness of brief alcohol interventions in primary care settings

2009-07-04T16:21:00.002+01:00

My thanks to Chris Ford to alerting me to a systematic review of brief alcohol interventions in general practice.

The systematic review showed that in the set of trials analysed, brief intervention led to greater reductions in drinking among risky drinkers than just asking about drinking, or usual clinical care, and that the research would generalise to routine general practice.

The review can be found at the Drug and Alcohol Findings website:

http://findings.org.uk/count/downloads/download.php?file=Kaner_E_7.txt

DS Daily

2009-06-10T23:21:00.004+01:00

DrugScope has launched a new daily drug and alcohol news service called DS Daily.

To register to receive DS Daily, please go to:

http://www.dsdaily.org.uk/

Working Hard

2009-05-20T22:39:00.002+01:00

All work and no play makes Jack a dull boy.......

So I thought I should add a picture of me relaxing.

New Release Website

2009-05-20T22:20:00.002+01:00

Release is the national centre of expertise on drugs and drugs law - providing free and confidential specialist advice to the public and professionals. It also campaigns for changes to UK drug policy to bring about a fairer and more compassionate legal framework to manage drug use in our society.

Release has recently launched a completely re-vamped web site which is worth a visit:

http://www.release.org.uk/

From Cradle to Grave

2009-05-20T22:13:00.004+01:00

Were you at this years RCGP conference in Liverpool at the beginning of May?

Unfortunately I had another commitment and could not go. But if you were and wanted to catch up, or you missed it like me and want to see what went on, then the conference papers are posted on the SMMGP website:

http://www.smmgp.org.uk/html/rcgpconference.php#2009

Treatment works

2008-12-04T23:13:00.003Z

Although I am not a fan of the way that the criminal justice system is driving the treatment of substance users, the NTA have published some evidence to show that treatment works - in reducing the harm to society at large.

The research briefing published this month, 'Changes in offending following prescribing treatment for drug misuse', shows that in a sample of opiate and crack users who had recently offended and had started drug treatment in the community, the number of offences committed almost halved following the start of treatment. Also the longer this group was in treatment the fewer follow-up offences were committed.

This document is available at:

http://www.nta.nhs.uk/publications/documents/nta_changes_in_offending_rb35.pdf

Shooting Up

2008-11-20T17:14:00.004Z

Infections among injecting drug users in the United Kingdom 2007

The Health Protection Agency has published the data obtained from the 'Unlinked Anonymous Prevalence Monitoring Programme' survey of injectors. There is addition information about bacterial infections.

http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1224833091550

Well worth a read.

Perfect Day

2008-09-17T22:19:00.003+01:00

I always found it a bit odd that the BBC chose Perfect Day by Lou Reed as their song for the Children in Need appeal in 1997, particularly as it had featured in the film 'Trainspotting' the year before. I find the last lines 'You're going to reap, just what you sow,' very poignant.

http://www.youtube.com/watch?v=d8OfKdOFR_c&feature=related

What no post....

2008-09-17T22:06:00.002+01:00

It has been a while since my last post, largely because I have been busy after my holiday. So here is a gratuitous picture of from my holiday. I went to Cuba with the family and had an excellent time. Spent four days in Havana and 10 days on the beach at Varadero. It is fascinating place; beautiful buildings, wonderful beaches, friendly people, lots of rum and very safe. If you get the chance, go.

Methadone mixture or oral solution?

2008-09-17T21:45:00.004+01:00

Which do you use on prescriptions? Well the advice from the Royal Pharmaceutical Society is that it is better to use 'oral solution'.

My thanks to Marion Walker for providing the following:
"The NTA has contacted the RPSGB for their advice and they referenced the following page on the Society's website containing controlled drug FAQs:

http://www.rpsgb.org/worldofpharmacy/useofmedicines/controlleddrugs.html#faqss

'5. If a prescription is written for Methadone mixture, can I supply Methadone oral solution?
If a mixture was prescribed, as an oral solution is a type of mixture, this could be supplied.
6. If a prescription is written for Methadone oral solution, can I supply Methadone mixture?
If an oral solution is prescribed, a mixture could only be supplied if the product's licence stated that its form was an oral solution.
If an oral solution is prescribed, a mixture must not be supplied where it is not an oral solution, e.g. where it is an oral suspension etc. '

The RPSGB also stated that it has received confirmation from the Home Office that the above information reproduced in the CD FAQs is acceptable.

The background information resulting in the publication of these FAQs was as follows:
An oral solution contains active ingredient(s) dissolved in a suitable vehicle, while a mixture contains active ingredient(s) dissolved, suspended or dispersed in a suitable vehicle. While all oral solutions can be described as mixtures, not all types of mixtures are oral solutions.
When methadone mixture was first formulated, it was a preparation which was a solution of methadone hydrochloride in the vehicle. As methadone is highly soluble, there is no record of any formulation as a suspension or dispersion of methadone. Those described as mixtures have always been solutions.

The original formula adopted for methadone mixture never had any official status in the UK, having never appeared in the British Pharmaceutical Codex or the British Pharmacopoeia. However, the formula was published in the Drug Tariff and became known as Methadone Mixture DTF (drug tariff formula). This accorded the formula a form of semi-official status and it was widely used in the extemporaneous preparation of methadone mixture, and was regarded at that time as the only formula to use.

With the inclusion of an official monograph in the British Pharmacopoeia for Methadone Oral Solution (1 mg per mL), this should be the term used to describe the preparation; the term methadone mixture 1 mg/mL appears to have been superseded and relates to a non-official preparation.

The Home Office's view was sought and it was determined that the following advice could be given:
1) If an oral solution is prescribed, a mixture could be supplied only if the product's licence stated that its form was an oral solution.
2) If an oral solution is prescribed, a mixture must not be supplied where it is not an oral solution, i.e. where it is an oral suspension etc.
3) If a mixture was prescribed, since an oral solution is a type of mixture, this could be supplied.

The specific query refers to a pharmacist who refused to dispense a prescription for methadone mixture because the product in stock was labelled methadone oral solution. However, from the RPSGB and the Home Office guidance, it can be seen that the term methadone mixture is legally acceptable on a prescription and methadone oral solution can be dispensed against such a prescription. However, the term "methadone mixture" is likely to become increasingly obsolete as the official monograph is now methadone oral solution.

When a manufacturer updates the summary of product characteristics (SPC) with the Medicines Healthcare Regulatory Agency (MHRA), who approve SPCs, the MHRA now insist that only "oral solution" or "oral suspension" are the terms that can be used. If a manufacturer wants to use the term mixture this is refused unless the product (in the case of methadone mixture DTF) has historically had a licence as a mixture.

This means that in time (if it has not already happened) that all SPCs for methadone 1mg per ml will be called methadone oral solution. Methadone oral solution can be dispensed against prescriptions requesting either methadone oral solution or methadone mixture.

The Drug Misuse and dependence - clinical guidelines 2007 uses the official correct term "methadone oral solution" throughout the text of the guidelines but the prescription writing annex uses the example "methadone mixture" to demonstrate that this is also an acceptable way of writing the prescription."

Marion also says that there is a useful section on miscellaneous queries on the RPSGB website:

www.rpsgb.org/pdfs/cdfaqregsmisc.pdf

Two papers

2008-07-06T16:14:00.002+01:00

In the BMJ this week (5th July 2008 vol. 337 no. 7660 pg. 46) the clinical review is looking at the misuse of drugs in adolesence. While useful, the review seems too broad to cover any aspect in detail.

In the Lancet (28th June 2008 vol. 371 no. 9631 pg. 2192) a study of 126 patients who had been detoxified found that buprenorphine was more effective at preventing relapse than naltrexone, and that naltrexone was no better than placebo. The trial does have some limitations, not least that only 40 per cent of the patients given buprenorphine completed the 24 weeks of treatment and 25 per cent stayed on treatment and off heroin.

A free lunch....

2008-06-25T22:54:00.002+01:00

Not quite, but membership of the SMMGP is free! The benefits include:

SMMGP's Network Newsletter by post or e-mail.

Monthly clinical updates by e-mail, including 'Journal Watch'.

Monthly policy updates by e-mail.

Invitation to membership events.

Being part of the voice for the primary care substance misuse treatment field - the more people that join the stronger the voice.

The clinical update for June is 'Hepatitis C – A long way still to go' which looks at the results of the Healthcare Commission and NTA improvement reviews. It is a useful read with some good links.

To join the SMMGP, click the link:

http://www.smmgp.org.uk/html/contact/membershipform.php

Pain and substance misuse

2008-06-19T18:05:00.007+01:00

One of the areas I find most difficult is managing pain in substance misuses and vice versa - managing substance misuse in patients who suffer from pain.

There are community drug teams and there are pain clinics but the two don't often meet, although PANN did have a meeting last year to discuss this issue.

What I do find useful is a booklet published in April 2007 called 'Pain and substance misuse:
improving the patient experience'. This is described as a 'consensus statement prepared by The British Pain Society in collaboration with The Royal College of Psychiatrists, The Royal College of General Practitioners and The Advisory Council on the Misuse of Drugs'.

Despite such heavy weight authors it is very readable and there is a matching information booklet for patients.

Both can be viewed on the British Pain Society Website:

http://www.britishpainsociety.org/pub_professional.htm

Concentrated Orange Guidelines only

2008-06-11T22:01:00.004+01:00

There seems to be an increasing amount of concentrated methadone mixture - 10mg per 1 ml being prescribed, certainly in my neck of the woods. The Orange guidelines do not support this and strongly advise that only 1mg per 1ml methadone mixture should be prescribed.

The biggest risk is if the concentrated methadone is diverted then the risk of overdose to illicit users is huge. If you are the pharmacist make a mistake with the prescription then the risk of overdose or underdose is that much greater as well.

By sticking to 1mg per 1ml methadone mixture, we all know where we stand - prescribers, pharmacists, nurses and patients. So, unless you are a very experienced prescriber with a very stable patient, and you have very clear, justifiable reasons, then follow the orange guidelines and prescribe methadone mixture 1mg per 1ml.

U2 - Running to a Standstill

2008-05-03T22:52:00.004+01:00

I am a great fan of U2. They are incredible live.

Several of their songs are drug use especially heroin. 'Running to Stand Still' is from The Joshua Tree album. It is a soft, slow song about a heroin-addicted woman from the Ballymun Seven Towers area of Dublin hence the lyric "I see seven towers/But I only see one way out." The woman's addiction is reflected in lines such as "She runs through the streets/With her eyes painted red" and "She will suffer the needle chill." Bono's lyrics evoke helplessness and frustration: "You've got to cry without weeping, talk without speaking, scream without raising your voice."

This clip is from their live album 'Rattle and Hum'.

http://www.youtube.com/watch?v=HhQSeVjC-_Q&feature=related

Should heroin be prescribed to misusers?

2008-04-22T15:57:00.006+01:00

If you had missed the BMJ issued on 12th January, it is worth a read.

There are two articles. Firstly an overview into the research into prescribing injectable heroin for users. This is general review of thre prescribing in this country and the research undertaken in Switzerland, Holland and Germany. The full internet version is only available to subscribers.

http://www.bmj.com/cgi/content/extract/336/7635/68

The second is a 'head-to-head' feature which debates the pros and cons of prescribing heroin. Unfortunately both arguments appear quite bland and limited in their breadth, leaving the reader unlikely to decide in either direction but to suggest that more evidence is required. These appear to be free to non-subscribers.

http://www.bmj.com/cgi/content/full/336/7635/70

Hurt

2008-04-17T23:45:00.008+01:00

http://www.youtube.com/watch?v=SmVAWKfJ4Go&feature=related

This song is about heroin. It was written by Trent Reznor of Nine Inch Nails but Johnny Cash recorded it shortly before he died in September 2003.

Cash's version is a reflection on mortality. It is an incredibly powerful and moving performance.

Making a start

2008-04-17T23:27:00.002+01:00

They told me that this would be easy..........

This is my first post, I hope of many. I hope that this blog will allow anyone who treats substance misusers in Greater London to stay in touch with current events. Although aimed at all those doctors, patients, nurses, shared care workers, prison staff and pharmacists who have taken part one or two of the RCGP certificate in the management of substance misusers in primary care, I hope that other workers will find this blog useful, infomative and fun.

All I have to do now is find out who you all are.