Drug Misuse Services Research Articles

Contact with treatment services among arrested drug users

Aims and MethodTo identify the proportion of arrested drug misusers with prior contact with treatment services, police surgeons' records were examined over a 12-month period and compared with the records of the local drug misuse services. Both referrals and those who attended with face-to-face contact were noted.ResultsSixty-seven per cent of drug-related cases had been referred to services prior to arrest and 58% had attended with face-to-face contact on at least one occasion. Homeless and male drug users were more likely to have had no past contact. Police surgeons treated three-quarters of the cases for opiate dependence. Drug misusers were much more likely to have had past contact with services than arrested alcohol misusers, and were more likely to reoffend.Clinical ImplicationsThe evidence base for motivational enhancement in the transient coercive setting of police custody is not established, and arrest referral schemes might not be cost-effective in areas where most cases have had previous contact with services. Local research may contribute to more informed decisions about these treatment-related criminal justice initiatives.

Finding a vein or obtaining consent: a qualitative study of hepatitis C testing in GP methadone clinics.

Informed consent is a professional norm, but the promotion of testing for infectious disease in organized clinics and the introduction of targets for uptake, such as those for human immunodeficiency virus (HIV) testing in antenatal clinics, might impair truly voluntary consent. Hepatitis C virus (HCV) is highly prevalent among intravenous drug users (IDUs) and the 'offer' of a serological test for HCV antibodies is now seen as a national standard within drug misuse services, including GP methadone clinics. We hoped that GPs' descriptions of the context and offer of HCV testing could provide an exploratory study of consent within primary care clinics. The aim of this study was to understand GPs' ethical practice when negotiating consent to HCV testing with IDUs. A qualitative semi-structured interview study of 20 GPs in Greater Manchester was carried out. GPs reported that they or their attached drug workers commonly tested for HCV, and many stressed the need for good teamwork and building relationships with 'stable' IDUs before testing. GPs' views on the beneficence of testing and their practices in obtaining consent were diverse. GPs' discourse highlighted important management problems: (i) the adequacy of preparation of some IDUs for testing; (ii) 'opportunistic' HCV testing; and (iii) GPs' recognition of denial after testing. While GPs offered little explicit ethical reflection, occasionally they remarked on tendencies to control a patient's decision, and a deviant case analysis demonstrates how poor teamwork can be associated with coercion. GPs' descriptions suggest that an effective informed consent process is the norm for HCV testing within GP methadone clinics. Importantly, a minority of GPs alluded to the directive effect of team protocols or other problems in obtaining valid consent. We offer recommendations for managing testing to ensure voluntary choice.

Contact with treatment services among arrested drug users

Aims and Method To identify the proportion of arrested drug misusers with prior contact with treatment services, police surgeons' records were examined over a 12-month period and compared with the records of the local drug misuse services. Both referrals and those who attended with face-to-face contact were noted. Results Sixty-seven per cent of drug-related cases had been referred to services prior to arrest and 58% had attended with face-to-face contact on at least one occasion. Homeless and male drug users were more likely to have had no past contact. Police surgeons treated three-quarters of the cases for opiate dependence. Drug misusers were much more likely to have had past contact with services than arrested alcohol misusers, and were more likely to reoffend. Clinical Implications The evidence base for motivational enhancement in the transient coercive setting of police custody is not established, and arrest referral schemes might not be cost-effective in areas where most cases have had previous contact with services. Local research may contribute to more informed decisions about these treatment-related criminal justice initiatives.

A qualitative study of GPs' attitudes to drug misusers and drug misuse services in primary care.

Due to a growing drug misuse problem in Scotland, GPs increasingly are being called upon to deal with and treat misusers. With the publication of government guidelines in 1999, debate on this subject has intensified, with some GPs questioning their role in the treatment of drug misuse. This study explored, in depth, GPs' views and experiences of providing services for drug misusers such as methadone maintenance, use of guidelines and shared care schemes. Factors influencing their treatment of drug misusers were covered. Forty-eight semi-structured GP telephone interviews were conducted and their responses recorded, transcribed and analysed using qualitative content analysis. The sample was purposive and included a spread of individuals from varying age groups, levels of involvement with drug misuse and training, as well as gender and health board. Transcripts were validated with a 50% sample of interviewees, allowing them to correct any opinions they felt were not represented accurately. GPs increasingly accept a role in the treatment of drug dependency, although a shared care model was preferred due to the workload implications of this patient group. A drawback of shared care was long waiting lists. Patient behaviour emerged as a strong theme influencing treatment, and safety concerns were evident. Views of methadone maintenance were mixed, and it was considered as the only real option available. Themes identified from the interviews reinforced the patterns of past research. GPs are becoming more confident and comfortable with misusers, and more positive towards methadone and methadone maintenance treatment, but still feel that they lack the necessary knowledge and skills.

A survey of community pharmacists on prevention of HIV and hepatitis B and C: current practice and attitudes in Grampian.

Prevention of infection with the blood-borne pathogens (BBPs) HIV and hepatitis B and C remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacists in Grampian in prevention of HIV and hepatitis B and C. A questionnaire survey of community pharmacies was carried out in Grampian, a mixed urban-rural Health Board area in NE Scotland with a population of 532,432. Ninety-nine out of 128 (77 per cent) community pharmacies responded. Many pharmacies were providing services for drug misusers. Nearly all pharmacies stocked condoms, 57 pharmacists stated that they stocked extra-strong condoms, and two stocked dental dams. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Less than half stated that they had lists of local agencies dealing with drug-related or sexual health problems. Knowledge of the BBPs, and confidence in giving advice, were greater for HIV than for hepatitis B and C. Few were aware of recommendatons for hepatitis B vaccination. The majority felt that in the future pharmacists could have a greater role in prevention of these infections. Principal barriers to preventive activity were described as time pressure, lack of a private area and lack of training. There is untapped potential for community pharmacists to be a focus for advice and information relating to prevention of HIV and hepatitis B and C; however, resources are needed to address the current barriers identified field.

Intensive care expenditure on overdose admissions

In Scotland, 3% of intensive care admissions relate to drug overdoses. In Greater Glasgow, €12 million are annually spent on drug misuse services. UK studies have related a therapeutic intervention scoring system (TISS) to expenditure [1]. We investigated the costs of overdose admissions in a teaching hospital intensive care unit (ICU) from 1 January 1997 to 31 December 2000.

Community pharmacy services for drug misusers in Scotland: what difference does 5 years make?

To assess current levels of participation of community pharmacists in needle exchange provision, assess participation in dispensing any drugs for drug misuse, explore methadone dispensing practice, assess involvement in health promotion for drug misusers, assess levels of training in drug misuse and compare all of the above with data from 5 years previously. A cross-sectional postal questionnaire. All community pharmacies in Scotland (n = 1162). A total of 969 pharmacists managing community pharmacies on a day-to-day basis (response rate 83.4%). Descriptive data were collected on demography, drug misuse services provided and training. Data were combined with a dataset from an identical survey conducted 5 years previously for statistical comparison. Levels of needle exchange provision has not changed significantly (9.7% in 2000 compared to 8.6% in 1995). Of all respondents, 71.5% now dispense drug for the management of drug misuse, 68.9% dispense methadone and 56.7% provide a supervised methadone consumption service. The number of methadone clients receiving methadone through pharmacies has increased from 3387 in 1995 to 8792 in 2000 and the mean number of clients dispensed methadone per pharmacy has increased from 7.3 in 1995 to 13.2 in 2000; 65.1% of all methadone clients now consume their methadone under pharmacist supervision. The proportion of pharmacists dispensing methadone who provide a supervised consumption service has increased significantly from 37% to 82.8%. Considerable changes in pharmacy practice are evident with significant increases in the number of pharmacists who always lay down ground rules, ask for identification on first visits, make up prescriptions in advance and provide verbal advice and leaflets on the management of drug misuse. Training in drug misuse doubled from 31.8% to 66.8%. Community pharmacy involvement with drug misusers has increased dramatically in the last 5 years. However, this increase is largely in methadone dispensing and supervision. Pharmacists appear to be more proactive in providing advice and information, perhaps as a result of greater training.

The prevalence and management of co‐morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations

AbstractA cross‐sectional survey of clinical staff was carried out among statutory (public sector) substance misuse services and community mental health teams (CMHTs) in an inner London borough. We identified 368 current patients of drug and alcohol misuse services and 930 current patients of CMHTs. We measured the prevalence of co‐morbid substance misuse and mental illness among these patients. We found strong evidence of co‐morbid mental health problems in 128 substance misuse patients (34.8%) and evidence of possible co‐morbidity in a further 18.5% of cases. Among mental health service patients, 227 (24%) were reported to have current substance misuse problems. Shared care of patients was uncommon and only a minority of co‐morbid patients received treatment for both problems or the specialist assessment which key workers felt they needed. The findings suggest that co‐morbidity is highly prevalent among mental health and substance misuse patients. Further research is needed to corroborate these findings, but the development and provision of evidence‐based treatment and service interventions is likely to become an increasing priority.

Service innovation in drug misuse services

This review looks at the need for partnerships in delivering services for drug misusers, to provide a broad base service. It reviews a number of specific partnerships set up between statutory and non statutory agencies based upon identified need and demonstrates the improvement in outcomes that can be achieved through partnerships interventions. In conclusion it reviews some of the basic lessons learnt in the process of setting up successful partnerships particularly the need for joint training between agencies.

The Consultancy Liaison Addiction Service - the first 5 years of an integrated, primary care-based community drug and alcohol team

Government policy, running through the 10-Year Drug Strategy, Tackling Drugs to Build a Better Britain (The Stationery Office, 1998) and the New Drug Misuse Clinical Guidelines (Department of Health, The Scottish Office, 1999) highlights the need for health authorities and now PCGs to invest in shared care mechanisms to support primary care in its task of caring for drug misusers. Primary Care Trusts, as freestanding NHS organizations, will in time be able to commission, purchase and provide these services themselves, using primary care expertise alongside specialists. This paper describes a model of primary care-based shared care service, the Consultancy Liaison Addiction Service, that has been in operation for 5 years in South London, that predates these changes in the NHS yet could be considered by PCGs or PCTs when planning services for drug misusers. The service comprises a team of drug and alcohol community psychiatric nurses, supported and managed by a principal in general practice. Together they have worked with 72 neighbouring general practices, supporting the treatment of alcohol-misusing and drug-misusing patients. The team has a separate identity from, but is closely integrated into the secondary specialist addiction service producing effective continuum of care.

A Share of the Action: General Practitioner involvement in drug misuse treatment in Greater Manchester

This paper describes the development of shared care for drug misuse in Greater Manchester. Particular attention is given to Trafford, where a successful system has been developed involving all GPs in the district, and which provides direct access for GPs to a variety of support services for drug misusers, including training, rehabilitation and supported home detoxification. The Greater Manchester Shared Care Training Initiative is described. Local research is summarized relating to GP and patient attitudes. Unfortunately, there is still much resistance by GPs to involvement in treating illicit drug misuse. The authors draw on their experience of developing shared care schemes in a number of districts, and suggest ways of overcoming resistance among GPs and primary care staff. Attention must be paid to the attitudes and skill base of primary care staff, the amount of support they receive and the effectiveness and enthusiasm of the specialist service. An important first step is to recruit at least a few local GPs as champions of shared care. With the help of appropriate training and support, and sensitive evangelism, most GPs can be brought to realize that treatment of drug misuse is a satisfying and beneficial component of normal family practice.

Attitudinal factors associated with community pharmacists' involvement in services for drug misusers.

To assess the relationship between pharmacists' attitudes towards drug misusers and the availability and provision of services for drug misusers. A cross-sectional postal questionnaire survey. All community pharmacies in Scotland (n = 1142). A total of 864 pharmacists managing community pharmacies on a day-to-day basis (response rate 79%). Descriptive data were collected on demography, drug misuse services provided and training in drug misuse. Attitude statements were used to measure attitudes to drug misusers, the role of the pharmacist in dispensing controlled drugs and providing injecting equipment, providing advice on drug misuse and financial aspects of service provision. Statements were incorporated into a scale which was correlated with behavioural data on whether and how services were provided. The attitude scale had good internal reliability and was unidimensional. Pharmacists that provided needle/syringe exchanges, sold needles/syringes, dispensed methadone, supervised the consumption of methadone and provided health promotion services to drug misusers had significantly more positive attitudes towards drug misusers. Attitudes were associated with health board area, sex and number of years registered as a pharmacist. After controlling for these characteristics, attitude was an independent predictor of whether needles/syringes were sold, methadone was dispensed and methadone consumption supervised. Addressing negative attitudes could encourage more pharmacists to provide services and enhance the process of service delivery.

Effect of government recommendations on methadone prescribing in south east England: comparison of 1995 and 1997 surveys

On instruction from the Minister of Health, the Department of Health in England convened a task force on the effectiveness of treatment services for drug misusers, and widely distributed its...

Community pharmacy in Wales: 1995 data on HIV prevention and drug misuse services

Using a postal questionnaire mailed to a random one in four sample of community pharmacies in Wales, information on service provision for drug misusers, attitude towards services, and participation in training was obtained. After four mailshots, the final response was 137/178 pharmacies (77%). Forty- one per centofrespondents were dispensing controlled drugs for thetreatmentofaddiction, 34% were selling injecting equipment, and 31% were operating a needle exchange scheme- all substantial increases since 1988. Four-fifths believed the community pharmacist had a role to play in HIV prevention and two-thirds indicated a need for service-specific training. Two-fifths of respondents were in favour of a role for community pharmacists supervising the consumption of methadone in the pharmacy. The results also indicate further scope for increasing participation in service provision and for an expanded role for the community pharmacist, with suitable training and support.

Missed Opportunities: Drugs and Drugs Education

Increasing public concern about the extent of adolescent drinking, smoking and illicit drug use has been addressed by a number of Government initiatives. The 1996 Task Force to Review Services for Drug Misusers has recommended the development of services specifically for young people, whilst the White Paper Tackling Drugs Together (1995) recommended that youth services and other agencies aim to reduce experimental behaviour amongst adolescents not yet using drugs, and to encourage cessation and abstinence among those already initiated. Furthermore, drugs education has become a statutory part of the Science Curriculum in both primary and secondary schools, a measure further supported by two guidance documents from the Department for Education and the School Curriculum Assessment Authority. Circular 4/95 Drug Prevention and Schools, (DfE, 1995) and Drug Education: Curriculum Guidance for Schools (SCAA/DfE), essentially set out the expected broader policy and curriculum framework for schools implementing drugs education beyond the minimum statutory requirements. These policy developments have come about as a consequence of the extensive literature which shows increasing levels of substance experimentation and misuse amongst young people throughout the United Kingdom, and reflect the view evident in the White Paper, that education is a central plank of drugs prevention. This paper describes the outcomes of a collaborative project in three London Boroughs.

The Development of Services for Drug Misusers on Mersey

It is 10 years since the now famous statement by the Advisory Council on the Misuse of Drugs that, The spread of HIV is a greater danger to individual and public health than drug misuse. Accordingly, services which aim to minimise HIV risk behaviour by all means should take precedence in development plans' (ACMD, 1988), and the acceptance, at least for a time, of harm reduction as a legitimate goal for drug service provision. However, 2 years earlier Mersey Regional Health Authority (MRHA), now part of North West Regional Health Authority, had already planned such an approach in response to the urgent need to prevent the spread of HIV amongst a drug-misusing population estimated to be as high as 20,000 (DHMU, 1990). This paper looks at the development of services on Mersey and at events since then.

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training

To investigate the attitudes of community pharmacists towards HIV prevention services for drug misusers and the relationship between these and their involvement in service provision. Postal survey of a one in four random sample of community pharmacies (N = 2654) in England and Wales, stratified by Family Health Service Authority, in 1995, using up to four mailshots. Community pharmacies in England and Wales. The community pharmacist in charge of the dispensary at the random sample of community pharmacies. Information on attitudes and behaviour were collected through self-completion and postal return of structured questionnaires using questions with both category responses and Likert scales. A 74.8% response rate was achieved. Community pharmacists were positive about their role in HIV prevention and the provision of clean injecting equipment to injecting drug users--positive attitudes that were more evident among those pharmacists already providing these services. However, they had concerns over the effect drug misusers may have on business and indicated a need for more training and for more role support. Only a minority had taken part in training on drug misuse and HIV prevention (34.7% and 21.3%, respectively). Many community pharmacists supported the proposal that there should be extensions of their involvement, to include services such as supervising the consumption of methadone in the pharmacy (38.6%) and collecting used prescribed ampoules from patients (33.8%). Positive relationships were identified between training and attitude, and between attitude and service provision. Changes in attitude responses between this 1995 survey and the earlier 1988 survey are also presented. Recommendations are made for further training and greater communication between prescriber/carer and the community pharmacists, for involvement of community pharmacies in new possible forms of service provision, and for there to be greater attention to the value of role support.

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training

Task force to review services for drug misusers

In the past ten years there has been enormousgrowth in the size and the range of services forpeople who misuse illicit drugs. The blueprint forservice development was a report from theAdvisory Council on the Misuse ofDrugs entitledTreatment and Rehabilitation (Department ofHealth and Social Security, 1982). In response,growth of the non-statutory sector was particularly encouraged and the whole venture wasfunded through a series of Department of Healthinitiatives aimed at both the prevention of thespread ofHIVinfection and the ofdrugdependence. The time was right in the mid-1980s for the renaissance of harm reduction.The government was willing to accept anymeasures to prevent an AIDS epidemic, non-statutory agencies were in the ascendancy, andthe fieldlacked any convincing viewon treatmenteffectiveness. Guidance from the Advisory Council on the Misuse ofDrugs (Department ofHealthand Social Security, 1988; Department ofHealth, 1993), however, was careful not toendorse wholesale adoption of a harm reductionapproach, but rather to see, for example, needleand syringe exchange schemes and substituteprescribing as useful elements of a public healthstrategy which both contained the spread of HIVand initiated the process of becoming drug free.The Department of Health has run an effectiveHIV control programme but, as perceptions ofrisk from HIV have diminished, new concernshave come onto the drugs agenda for the late1990s. Fear of an AIDS epidemic has beenreplaced by fears of criminal activity, and thependulum has again swung against too liberal aninterpretation of harm reduction. Prescribingdrugs for drug misusers has always beencontentious and expensive; therefore, a reversalofthe harm reduction policywas expected when,in 1994, Ministers set up a task force to reviewthe effectiveness ofservices . . in relation to theprincipal objective of assisting drug users toachieve and maintain a drug free state ...(Department of Health, 1996a). The task forceconsisted of 11 members.Tackling Drugs Together (Department ofHealth, 1995) committed the Department ofHealth to produce purchasing guidance for1997-1998, based on the task force review.Tackling Drugs Together identified a reductionin the acceptability and availability of drugs toyoung people, an increase in the safety ofcommunities from drug-related crime, and areduction in the health risks and other damagerelated to drug misuse as key elements ofgovernment strategy. In response, the task forceset out to map and categorise existing services,and to conduct a multi-centre study of treatmentprocesses and outcomes, referred to as NTORS(National Treatment Outcome Study). NTORSisa prospective, uncontrolled trial which hasrecruited 1110 subjects. The central finding fromNTORSso far is that treatment works in termsof reducing drug involvement, improving health,reducing criminal activity, and improving psychological well-being.All four modalities investigated (in-patient, residentialrehabilitation, methadone maintenance andmethadone reduction) have shown benefit, maintained at six-month follow-up.It is of interest formental health workers that the percentage ofpeople reporting feeling hopeless about thefuture fell from 63 to 44% and those expressingsuicidal thoughts from 29 to 16%.The follow-upwill continue for fiveyears.The task force is imprecise in categorisingmethadone programmes and is content thatany prescribing programme delivers both socialand health benefits. However, Raistrick (1997)has argued that the specific purposes of substitute prescribing must be understood by bothpurchasers and providers. These purposes, mostsimply characterised as social control, individualtreatment of dependence and protection of thepublic health, have implications for the source offinance, case management and service deliverysystems. The Amsterdam model (Plomp et al,1996) has successfully operationalised roles forgeneral psychiatrists, general practitioners andpsychiatrists specialising in substance misuse,and recognises that doctors are used to caring forindividuals rather than acting as agents of socialpolicy. Clarity of purpose should form the basisof substitute prescribing.Surprisingly the task force rather neglects therole of the general psychiatrist. This is

Maximizing the opportunity for a national minimum data set

Drug and Alcohol ReviewVolume 16, Issue 3 p. 205-206 Free Access Maximizing the opportunity for a national minimum data set Jan Copeland, Jan Copeland National Drug and Alcohol Research Centre University of New South Wales, Sydney, NSW 2052, AustraliaSearch for more papers by this authorJudy Rankin, Judy Rankin National Drug and Alcohol Research Centre University of New South Wales, Sydney, NSW 2052, AustraliaSearch for more papers by this author Jan Copeland, Jan Copeland National Drug and Alcohol Research Centre University of New South Wales, Sydney, NSW 2052, AustraliaSearch for more papers by this authorJudy Rankin, Judy Rankin National Drug and Alcohol Research Centre University of New South Wales, Sydney, NSW 2052, AustraliaSearch for more papers by this author First published: 29 May 2009 https://doi.org/10.1080/09595239800187371AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 The Task Force to Review Services for Drug Misusers. Report of an independent review of drug treatment services in England. London, Department of Health, 1996. 2 Maynard A. Evidence-based medicine: an incomplete method for informing treatment choices. Lancet 1997; 349: 126– 8. 3 National Health Data Committee. National health data dictionary, Version 5.0. Canberra, Australian Institute of Health and Welfare, 1996. Volume16, Issue3September 1997Pages 205-206 ReferencesRelatedInformation