Jenny Keen

The effect of time spent in treatment and dropout status on rates of convictions, cautions and imprisonment over 5 years in a primary care‐led methadone maintenance service

BACKGROUND Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations. AIMS To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service. DESIGN Cohort study. SETTING The primary care clinic for drug dependence, Sheffield, 1999-2005. PARTICIPANTS The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years. INTERVENTION The intervention consisted of MMT provided by GPs in a primary care clinic setting. MEASUREMENTS Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records. FINDINGS The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment. CONCLUSIONS MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions.

Managing drug misuse in general practice. New department of health guidelines provide a benchmark for good practice.

Guidelines on the clinical management of drug misuse were first issued by the Department of Health in 1991. The latest version, issued last month,1 has been long awaited and has already sparked controversy. The new guidelines focus more on the role of the generalist than on that of the specialist in drug misuse, so they are particularly relevant to general practitioners. The differences between the new and the old guidelines reflect changes over the decade both in our knowledge of drug misuse and in service delivery. Firstly, the new guidelines emphasise the developing evidence base, particularly the strong evidence for the effectiveness of methadone maintenance treatment.2 Secondly, they recognise the importance of the structure of service delivery and the key role of shared care within this. The new guidelines place responsibilities not just on doctors but also on commissioning bodies to deliver a service and to support doctors. Thirdly, …

Predicting biopsychosocial outcomes for heroin users in primary care treatment: a prospective longitudinal cohort study.

BACKGROUND Opiate substitution treatment for heroin users reduces mortality, illicit drug use, crime, and risk-taking behaviour, and improves physical, mental and social functioning. Few extended studies have been carried out in UK primary care to study factors predicting recovery. AIM To establish whether primary care opiate substitution treatment is associated with improvements in outcomes over 11 years, in delivering recovery, and to identify predictive factors. DESIGN AND SETTING A prospective longitudinal cohort study, with repeated measures in the Primary Care Addiction Service, Sheffield, 1999-2011. METHOD A total of 123 eligible patients were assessed using the Opiate Treatment Index at entry to treatment and at 1, 5, and 11 years. Clinical records were used to assess factors including employment and discharge status. RESULTS At 11 years, there was a high rate of drug-free discharge (22.0%) and medically-assisted recovery (30.9%), and low mortality (6.5%). Continuous treatment was associated with being discharged drug free (P = 0.005). For those still in treatment, there were highly significant reductions in heroin use and injecting, and significantly improved psychosocial functioning. There were strong positive correlations between mental health, physical health, and social functioning. Patients in employment had significantly better psychological and social functioning (P = 0.017, P = 0.007, respectively). CONCLUSION Opiate substitution treatment is associated over 11 years with full recovery, drug-free discharge and medically-assisted recovery. There is a strong association between the psychosocial variables, suggesting that intervention in any one of these areas may have extended benefits, by impacting on related variables and employment. The best predictor of a drug-free discharge was continuous uninterrupted treatment.

Can a targeted GP-led clinic improve outcomes for street sex workers who use heroin?

Female street sex workers in the UK are often addicted to heroin, and sex work may be a result of the economic drive to fund this addiction. This study looks at outcomes of a primary care drugs treatment intervention for street sex workers who use heroin, using prescribed maintenance treatment with intensive health and psychosocial support. Thirty-four sex workers entered the study and 100% were retained in the study at 1 year. After 1 year, only 33% of participants were still sex workers. Quality of life had improved significantly and heroin use had reduced.

Commissioning Pharmacological Treatments for Drug Users: A Brief Review of the Evidence Base.

Aims: To provide a brief review of relevant existing evidence regarding pharmacological treatment for drug users, in order to enable commissioners and service providers to make informed decisions that are evidence based wherever possible. Methods: The review process involved an examination of key reference texts and literature derived from literature searches of the standard databases and including all the relevant Cochrane Reviews. Clinical relevance was of paramount importance. Findings: There are particular problems with the evidence base regarding drug treatments which make a total reliance on treatments with an established evidence base virtually impossible. The best evidence remains that for methadone maintenance treatment but there is emerging evidence for the effectiveness of a range of other treatments. This is evidence is summarized. Conclusions: Commissioners should be aware of the strong evidence base for some treatments and relative lack of evidence for others, although less well evidence based interventions may be commissioned for pragmatic reasons.