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Type
House
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Year
Department
Member
Blears, Hazel (75)
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Subject
Medical treatments (75)
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Publisher
To ask the Secretary of State for Health, when he expects the Government's strategy document on alcohol treatment to be published; what the reason for the delay is; and if he will make a statement. - I have been asked to reply.
To ask the Secretary of State for Health, when he expects the Government's strategy document on alcohol treatment to be published; what the reason for the delay is; and if he will make a statement. - I have been asked to reply.
Asked by
Norman Lamb
(Liberal Democrat)
Answered by
Hazel Blears
(Labour)
Answering body
Home Office
Type
Written questions
Status
Answered
Tabled on
1 December 2003
For answer on
9 December 2003
Answered on
9 December 2003
Norman Lamb: To ask the Secretary of State for Health when he expects the Government's strategy document on alcohol treatment to be
published; what the reason for the delay is; and if he will make a statement. [141984]
Ms Blears: I have been asked to reply. On 19 September the Prime Minister's Strategy Unit published their Interim Analytical Report
on the harms associated with alcohol misuse. This will help inform the development of the cross-governmental alcohol harm reduction
strategy for England. The final report setting out the strategy will be published in time for implementation to begin in 2004, and
in line with commitments given in the NHS Plan.
Subjects
Alcoholic drinks; Alcoholism; Medical treatments; Misuse
Date
9 December 2003
Reference
141984; 415 c366-7W
House
House of Commons
To ask the Secretary of State for Health, what recent assessment he has made of the use and abuse of alcohol in other EU countries with special reference to (a) binge drinking and (b) young people; what recent research he has commissioned into the treatment of alcohol abusers in the...
To ask the Secretary of State for Health, what recent assessment he has made of the use and abuse of alcohol in other EU countries with special reference to (a) binge drinking and (b) young people; what recent research he has commissioned into the treatment of alcohol abusers in the...
Asked by
Jim Cunningham
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
3 June 2003
For answer on
10 June 2003
Answered on
10 June 2003
Mr. Jim Cunningham: To ask the Secretary of State for Health (1) what recent assessment he has made of the use and abuse of alcohol
in other EU countries with special reference to (a) binge drinking and (b) young people; [117823]
(2) what recent research he has commissioned into the treatment of alcohol abusers in the European Union; [118608]
(3) what comparative research he has commissioned into the costs to health services in the EU of alcohol abuse. [118609]
Ms Blears: The Department of Health has been working closely with my right hon. Friend, the Prime Minister's strategy unit on a
project to develop the national alcohol harm reduction strategy. As part of this project, the strategy unit is due to publish an
interim analysis in the summer. The analysis will consider issues around treatment for those with an alcohol problem and the costs
to health services of alcohol-related harm. It will also make reference both to binge drinking and young people and will draw, where
relevant, on international and European comparisons. The final report, which will set out the cross-governmental alcohol harm
reduction strategy is planned for publication in the autumn.
Subjects
Alcoholic drinks; Costs; EU countries; Health services; Medical treatments; Misuse; Young people; Research
Date
10 June 2003
Reference
406 c828-9W; 117823;118608;118609
House
House of Commons
To ask the Secretary of State for Health, how many patients are being monitored for treatment for (a) drug addiction and (b) heroin addiction in the National Treatment Outcome Survey. - Including figures. (Holding answer 16 May 2003).
To ask the Secretary of State for Health, how many patients are being monitored for treatment for (a) drug addiction and (b) heroin addiction in the National Treatment Outcome Survey. - Including figures. (Holding answer 16 May 2003).
Asked by
Lord Mann
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
13 May 2003
For answer on
3 June 2003
Answered on
3 June 2003
Subjects
Alcoholic drinks; Drugs; Medical treatments; Misuse; Surveys; Heroin
Date
3 June 2003
Reference
113787; 406 c68W;406 c69W
House
House of Commons
To ask the Secretary of State for Health, what assessment he has made of the clinical effectiveness of ibogaine in treating drug addiction; and what funds are available for further trials.
To ask the Secretary of State for Health, what assessment he has made of the clinical effectiveness of ibogaine in treating drug addiction; and what funds are available for further trials.
Asked by
Lord Brady of Altrincham
(Conservative)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
6 May 2003
For answer on
22 May 2003
Answered on
22 May 2003
Mr. Brady: To ask the Secretary of State for Health what assessment he has made of the clinical effectiveness of ibogaine in
treating drug addiction; and what funds are available for further trials. [112364]
Ms Blears: No specific assessment has been made on the clinical effectiveness of this drug. It is not licensed for use in the
treatment of drug dependence. Licensing of medicines in the United Kingdom is determined by science. The same standard of safety and
efficacy would be required for ibogaine as for any other medicine.
Subjects
Finance; Drugs; Medical treatments; Misuse; Rehabilitation; Clinical trials; Ibogaine
Date
22 May 2003
Reference
112364; 405 c960W
House
House of Commons
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Oral answers to questions
Subjects
Drugs; Medical treatments; Misuse; Rehabilitation; South Wales
Date
22 May 2003
Reference
405 c328-9WH
Chamber / Committee
Westminster Hall
House
House of Commons
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Oral answers to questions
Subjects
Drugs; Medical treatments; Misuse; Benzodiazepines
Date
22 May 2003
Reference
405 c333WH
Chamber / Committee
Westminster Hall
House
House of Commons
Answered by
Hazel Blears
(Labour; Labour)
Answering body
Home Office
Type
Oral answers to questions
Subjects
Drugs; Medical treatments; Misuse; Drug treatment and testing orders
Date
22 May 2003
Reference
405 c337WH
Chamber / Committee
Westminster Hall
House
House of Commons
My hon. Friend is right. We face a problem: capacity in the drug treatment sector must be increased. We are starting from a low base, because that sector was not a high priority. Most of its capacity has come from very good voluntary sector providers, but they have not had the same of models of care, of standards and of work force development as other sectors. With the advent of the National Treatment Agency for Substance Misuse, capacity in the sector is now growing at a fairly phenomenal rate. Our estimates for growth for this year have been exceeded, so people are beginning to see the drug field as a worthwhile place to work and somewhere to build a career.
We are building better occupational standards to provide good-quality treatment, but my hon. Friend is right that there is much more to do to ensure that people can receive good, high-quality treatment from day one. That is exactly what we plan to do. With the criminal justice intervention programme, we plan to provide a Rolls-Royce service. As soon as people are referred, whether as a result of arrest referrals or of DTTOs, they will be held in the system and they will have a personal adviser to guide them through it. Increasingly, we need not only to refer for treatment, but to retain people in treatment and see them successfully through the programme. I acknowledge that we have much more to do, but the system is substantially improved from what it was a short time ago.
My hon. Friend is right. We face a problem: capacity in the drug treatment sector must be increased. We are starting from a low base, because that sector was not a high priority. Most of its capacity has come from very good voluntary sector providers, but they have not had the same of models of care, of standards and of work force development as other sectors. With the advent of the National Treatment Agency for Substance Misuse, capacity in the sector is now growing at a fairly phenomenal rate. Our estimates for growth for this year have been exceeded, so people are beginning to see the drug field as a worthwhile place to work and somewhere to build a career.
We are building better occupational standards to provide good-quality treatment, but my hon. Friend is right that there is much more to do to ensure that people can receive good, high-quality treatment from day one. That is exactly what we plan to do. With the criminal justice intervention programme, we plan to provide a Rolls-Royce service. As soon as people are referred, whether as a result of arrest referrals or of DTTOs, they will be held in the system and they will have a personal adviser to guide them through it. Increasingly, we need not only to refer for treatment, but to retain people in treatment and see them successfully through the programme. I acknowledge that we have much more to do, but the system is substantially improved from what it was a short time ago.
Answered by
Hazel Blears
(Labour)
Asked by
Martin Salter
(Labour)
Answering body
Home Office
Type
Oral answers to questions
My supplementary question is probably more relevant to the Health Minister. Do Ministers recognise that NHS providers of drug treatment services are not responding quickly enough in some areas? They are not meeting this national standard to respond to the orders made by the courts.
Recently, in Reading Crown court, a heroin addict was sentenced to a drug treatment and testing order after committing more than 40 offences of burglary and criminal deception to fund his addiction. Do Ministers agree that it is nothing less than shocking that the local national health service treatment service told him to come back and start his course in four weeks, which triggered yet another drug fuelled mini-crime wave? Will they authorise a review of the failure of NHS service providers in that regard?
Subjects
Drugs; Medical treatments; Misuse; Drug treatment and testing orders
Date
22 May 2003
Reference
405 c337WH
Chamber / Committee
Westminster Hall
House
House of Commons
Answered by
Hazel Blears
(Labour)
Asked by
Huw Irranca-Davies
(Labour)
Answering body
Department of Health
Type
Oral answers to questions
To ask for a statement on treatment and rehabilitation for drugs misuse. 1st Westminster Hall supplementary on need for further action and funds in South Wales.
Subjects
Drugs; Medical treatments; Misuse; Rehabilitation; South Wales
Date
22 May 2003
Reference
405 c328-9WH
Chamber / Committee
Westminster Hall
House
House of Commons
Answered by
Hazel Blears
(Labour)
Asked by
John Grogan
(Labour)
Answering body
Department of Health
Type
Oral answers to questions
To ask for a statement on dealing with the problems associated with benzodiazepine addiction. 1st Westminster hall supplementary on same.
Subjects
Drugs; Medical treatments; Misuse; Benzodiazepines
Date
22 May 2003
Reference
405 c333WH
Chamber / Committee
Westminster Hall
House
House of Commons
To ask the Secretary of State for the Home Department, What the minimum professional qualification is for making an assessment of heroin addiction treatment needs. (Failed Westminster Hall OPQ).
To ask the Secretary of State for the Home Department, What the minimum professional qualification is for making an assessment of heroin addiction treatment needs. (Failed Westminster Hall OPQ).
Asked by
Lord Mann
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
14 May 2003
For answer on
22 May 2003
Answered on
22 May 2003
Subjects
Drugs; Health professions; Medical treatments; Qualifications; Misuse; Heroin
Date
22 May 2003
Reference
114229; 405 c369WH
House
House of Commons
To ask for a statement on treatment and rehabilitation for drugs misuse. 1st Westminster Hall supplementary on need for further action and funds in South Wales.
To ask for a statement on treatment and rehabilitation for drugs misuse. 1st Westminster Hall supplementary on need for further action and funds in South Wales.
Asked by
Huw Irranca-Davies
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Oral questions - Lead
Status
Answered
Answered on
22 May 2003
Subjects
Drugs; Medical treatments; Misuse; Rehabilitation; South Wales
Date
22 May 2003
Reference
405 c328-9WH; 114220
Chamber / Committee
Westminster Hall
House
House of Commons
To ask for a statement on dealing with the problems associated with benzodiazepine addiction. 1st Westminster hall supplementary on same.
To ask for a statement on dealing with the problems associated with benzodiazepine addiction. 1st Westminster hall supplementary on same.
Asked by
John Grogan
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Oral questions - Lead
Status
Answered
Answered on
22 May 2003
Subjects
Drugs; Medical treatments; Misuse; Benzodiazepines
Date
22 May 2003
Reference
405 c333WH; 114222
Chamber / Committee
Westminster Hall
House
House of Commons
To ask the Secretary of State for Health, pursuant to his Answer of 1st April, Official Report, 402 c691W, if he will place a copy of Drug Misuse and Dependence-Guidelines of Clinical Management (1999); in the Library. - Inc fact that copies available in Library and at http://www.doh.gov/uk/drugdep.htm.
To ask the Secretary of State for Health, pursuant to his Answer of 1st April, Official Report, 402 c691W, if he will place a copy of Drug Misuse and Dependence-Guidelines of Clinical Management (1999); in the Library. - Inc fact that copies available in Library and at http://www.doh.gov/uk/drugdep.htm.
Asked by
Paul Marsden
(Liberal Democrat)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
14 April 2003
For answer on
7 May 2003
Answered on
7 May 2003
Mr. Paul Marsden: To ask the Secretary of State for Health pursuant to his Answer of 1 April 2003, Official Report, column 691W, if
he will place a copy of Drug Misuse and Dependence-Guidelines of Clinical Management (1999); in the Library. [110036]
Ms Blears: Copies of `Drug Misuse and Dependence--Guidelines on Clinical Management' are available in the Library. The document is
also available on the Department's website at http://www.doh.qov.uk/ drugdep.htm.
Subjects
Drugs; Medical treatments; Misuse
Date
7 May 2003
Reference
110036; 404 c765W;404 c761W
House
House of Commons
To ask the Secretary of State for Health, what research his Department has (a) commissioned into the number of methadone overdose deaths in the UK in the last 12 months for which figures are available and (b) evaluated on the role of methadone supervision in reducing overdose deaths. - Inc...
To ask the Secretary of State for Health, what research his Department has (a) commissioned into the number of methadone overdose deaths in the UK in the last 12 months for which figures are available and (b) evaluated on the role of methadone supervision in reducing overdose deaths. - Inc...
Asked by
Candy Atherton
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
28 April 2003
For answer on
7 May 2003
Answered on
7 May 2003
Ms Atherton: To ask the Secretary of State for Health what research his Department has (a) commissioned into the number of methadone
overdose deaths in the UK in the last 12 months for which figures are available and (b) evaluated on the role of methadone
supervision in reducing overdose deaths. [110598]
Ms Blears: The Office for National Statistics maintains a database that contains information on deaths from drug-related poisonings
for each year since 1993.
In 2001, the last year for which figures are available, there were 207 deaths where methadone was mentioned on the death
certificate. It should be noted that where more than one drug is mentioned on the death certificate, it is not always possible to
tell which of them was primarily responsible for the death.
Comprehensive reviews of the effectiveness of methadone have been provided by several authors (Hall et al., 1998, Farrell et al.,
1994, Bertschy 1995, Marsch, 1998). Most of those studies demonstrating the effectiveness of methadone are of on-going maintenance
treatment but the evidence generally becomes weaker as the duration of treatment shortens, with little systematic evidence to
support short-term detoxification. Specific studies include Fontain & Ansseau, 1995, Glass, 1993 and Gossop, M. et al., 2001. High
quality medical and psychosocial services, a clear orientation towards social rehabilitation, treatment longevity and slow
detoxification of well-stabilised patients have all been identified as giving the best outcomes, including reducing overdose deaths.
Subjects
Death; Drugs; Medical treatments; Misuse; Research; Methadone
Date
7 May 2003
Reference
110598; 404 c767W;404 c763W
House
House of Commons
To ask the Secretary of State for Health, whether the practice of automatic detoxification of patients stabilised in the community on substitute prescriptions has been discontinued. - Inc ref to 'Drug Misuse and Dependence - Guidelines on Clinical Management (1999)'.
To ask the Secretary of State for Health, whether the practice of automatic detoxification of patients stabilised in the community on substitute prescriptions has been discontinued. - Inc ref to 'Drug Misuse and Dependence - Guidelines on Clinical Management (1999)'.
Asked by
Paul Marsden
(Liberal Democrat)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
25 March 2003
For answer on
1 April 2003
Answered on
1 April 2003
Mr. Paul Marsden: To ask the Secretary of State for Health whether the practice of automatic detoxification of patients stabilised
in the community on substitute prescriptions has been discontinued. [105182]
Ms Blears: The Department of Health has never endorsed a policy of automatic detoxification of heroin misusers. Therefore, it would
be inaccurate to say that the policy of automatic detoxification of patients stabilised in the community on substitute prescriptions
has been discontinued. The Department's view is set out in its "Drug Misuse and Dependence--Guidelines on Clinical Management
(1999)", which states: "It is important to tailor the treatment needs to those of the individual needs of the presenting patient,
especially where substitute treatment for dependence is concerned. A dose reduction intervention should be shaped by a realistic
appraisal of jointly agreed treatment goals and outcomes between the patient, the doctor and other members involved in the patient's
care. Treatment aims and goals should be adjusted accordingly depending on the patients progress. Methadone maintenance treatment,
incorporating psychosocial interventions, can enable patients to achieve stability, reduce their drug misuse and criminal activity,
and improve health. For these reasons such treatment should form an important part of drug misuse services. There is now a choice of
substances available for use in opiate maintenance prescribing. There is a need to monitor research progress in this field and to
adjust future treatments in the light of new treatment evaluations."
Subjects
Drugs; Medical treatments; Misuse; Rehabilitation; Heroin
Date
1 April 2003
Reference
105182; 402 c690-1W;402 c691W
House
House of Commons
To ask the Secretary of State for Health, what plans he has to discuss drugs treatment with primary care trusts. - (Holding answer 18 March 2003).
To ask the Secretary of State for Health, what plans he has to discuss drugs treatment with primary care trusts. - (Holding answer 18 March 2003).
Asked by
Lord Mann
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
13 March 2003
For answer on
25 March 2003
Answered on
25 March 2003
John Mann: To ask the Secretary of State for Health what plans he has to discuss drugs treatment with primary care trusts.
[103534]
Ms Blears: [holding answer 18 March 2003]: The Government recognises that primary care trusts (PCTs) have a crucial role to play in
the delivery of effective drug treatment services. It is because of this that mechanisms have been set up to ensure that we have
regular contact with PCTs and other key stakeholders.
The National Treatment Agency for Substance Misuse (NTA) monitors the performance of all drug action team (DAT) members, including
PCTs, via a DAT treatment plan, which is completed on an annual basis. Progress against this treatment plan is reviewed by the NTA,
with all DAT partners, on a quarterly basis. These regular reviews ensure that all DAT partners are making a positive contribution
to the effective delivery of drug treatment services.
Subjects
Drugs; NHS; Medical treatments; Misuse; Primary care trusts
Date
25 March 2003
Reference
103534; 402 c192-3W
House
House of Commons
To ask the Secretary of State for Health, if he will commission research into opioid substitution therapy. - Includes fact that the National Treatment Agency for Substance Misuse (NTA) has recently published a briefing on the advice of its expert group on opioid treatment. Copies in in Library (Dep 03/817).
To ask the Secretary of State for Health, if he will commission research into opioid substitution therapy. - Includes fact that the National Treatment Agency for Substance Misuse (NTA) has recently published a briefing on the advice of its expert group on opioid treatment. Copies in in Library (Dep 03/817).
Asked by
Lord Mann
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
4 March 2003
For answer on
14 March 2003
Answered on
14 March 2003
John Mann: To ask the Secretary of State for Health if he will commission research into opioid substitution therapy. [101578]
Ms Blears: The National Treatment Agency for Substance Misuse (NTA) is aware that there is well- developed research evidence into
the use of opioid substitution therapy-- particularly into the effectiveness of oral methadone maintenance treatment. An important
part of the NTA role is to support high quality evidence based practice. It is recognised that some findings from the evidence base
are not fully implemented and the NTA has built a variety of mechanisms to support the implementation of key research findings into
to practice, including briefings, training, commissioning guidance and increasingly performance management systems. The NTA is also
working with the Department of Health to develop dissemination of the findings of its current drug treatment research programme. The
NTA has recently published a briefing on the advice of its expert group on prescribing, which includes a brief review of the
evidence base for opioid treatment.
Copies have been placed in the Library.
The NTA will commission new research in line with the outcome of its current priority setting exercise that is awaiting approval by
the NTA Board in March. Research bodies will be invited to submit tenders in line with these priorities.
Subjects
Drugs; Medical treatments; Misuse; Research; Opioids
Date
14 March 2003
Reference
101578; 401 c456W
House
House of Commons
To ask the Secretary of State for Health, how many problematic drug users were in treatment in each of the last five years. - Including table and fact that information is not available in the form requested.
To ask the Secretary of State for Health, how many problematic drug users were in treatment in each of the last five years. - Including table and fact that information is not available in the form requested.
Asked by
Simon Hughes
(Liberal Democrat)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
24 February 2003
For answer on
4 March 2003
Answered on
4 March 2003
Simon Hughes: To ask the Secretary of State for Health how many problematic drug users were in treatment in each of the last five
years. [99535]
Ms Blears: Information is not available in the form requested.
Following the closure of the Home Office Addicts Index in 1997, The regional drug misuse databases (RDMDs) were the main source of
information on people presenting to drug treatment services with a drug problem up to 31 March 2001. Information on the numbers of
users reported as presenting to drug treatment services for treatment in England is shown in the table.
A one-off exercise was carried out to estimate the number of drug users in England in contact with drug treatment agencies in
2000-01. Around 118,500 individuals were reported to be in contact with drug treatment agencies in England in 2000-01.
In April 2001 the national drug treatment monitoring system (NDTMS) was introduced. The figures from the NDTMS are not directly
comparable with information collected previously for the RDMDs. However, provisional estimates are that the number of problem drug
misusers who presented for treatment to drug treatment agencies and general practitioners in England in 2001-02 increased by around
8 per cent., over the previous year.
Number of users reported as presenting for treatment for drug misuse in England during the six months periods ending 30 September
1996 to 31 March 2001
_________________________________________________________________________________________________.
Six month period ending Number presenting for treatment
September 1996 24,879
March 1997 25,925
September 1997 21,996
March 1998 23,916
September 1998 28,599
March 1999 28,499
September 1999 30,545
March 2000 31,815
September 2000 33,093
March 2001 33,234
_________________________________________________________________________________________________.
Note:
Reporting to the RDMDs was voluntary; changes in the numbers may, at least in part, be due to changes in reporting practice.Source:
The Department of Health series of Statistical Bulletins "Statistics from the Regional Drug Misuse Databases". Bulletins for the six
months ending March 1998 onwards are available at http:// www.doh.qov.uk/public/work public health.htm The Department of Health
Statistical Press Notice "Provisional Statistics From The National Drug Treatment Monitoring System In England,
2QgVg2//http://www.doh.qov.uk/public/ spndruqsQ212.htm
Subjects
Drugs; Medical treatments; Misuse
Date
4 March 2003
Reference
99535; 400 c992-3W;400 c982-3W
House
House of Commons
To ask the Secretary of State for Health, what clinical trials there have been on heroin treatment using (a) methadone, (b) buprenorphine, (c) naltraxone, (d) psychotherapy and (e) residential rehabilitation.
To ask the Secretary of State for Health, what clinical trials there have been on heroin treatment using (a) methadone, (b) buprenorphine, (c) naltraxone, (d) psychotherapy and (e) residential rehabilitation.
Asked by
Lord Mann
(Labour)
Answered by
Hazel Blears
(Labour)
Answering body
Department of Health
Type
Written questions
Status
Answered
Tabled on
11 February 2003
For answer on
4 March 2003
Answered on
4 March 2003
John Mann: To ask the Secretary of State for Health what clinical trials there have been on heroin treatment using (a) methadone,
(b) buprenorphine, (c) naltraxone, (d) psychotherapy and (e) residential rehabilitation. [98153]
Ms Blears: Comprehensive reviews of the effectiveness of methadone have been provided by several authors (Hall et al., 1998, Farrell
et al., 1994, Bertschy 1995, Marsch, 1998). Most of those studies demonstrating the effectiveness of methadone are of on- going
maintenance treatment but the evidence generally becomes weaker as the duration of treatment shortens, with little systematic
evidence to support short-term detoxification. Specific studies include Fontain & Ansseau, 1995, Glass, 1993 and Gossop, M. et al.,
2001. High quality medical and psychosocial services, a clear orientation towards social rehabilitation, treatment longevity and
slow detoxification of well-stabilised patients have all been identified as giving the best outcomes (Cacciola et al 1998, Bertschy
1995). Randomised controlled trials (RCTs) show a relationship between higher doses (>50 mg) and reduced illicit drug use with
better treatment retention rates (Ward et al 1992, Ling et al 1996, Fontaine & Ansseau 1995 and D'Aunno & Vaughan 1992).
Buprenorphine has more recently been established as a potential effective alternative substitution treatment for some patients by a
number of studies such as those concentrating on effective doses including Johnson et al., 1995, Ling et al., 1998 and Strain et
al., 1994. Specific differences from methadone have been highlighted in other studies including Walsh et al., 1994, Reynaud et al.,
1998, Bickel & Amass, 1995, Reisinger, 1997 and Barnett P. G. et al., 2001) and trials in Europe have been reviewed by Chapleo et
al., 1997. Also see Uehlinger, C. et al. 1998 and Fischer, G. et al. 1999 for published studies.
The Cochrane review of buprenorphine maintenance for opioid dependence in August 2002 concluded `Buprenorphine is an effective
intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate
dosages.'
The effectiveness of naltrexone for relapse prevention has been demonstrated in controlled studies by Shufman et al., 1994 and Gerra
et al., 1995. Probation- linked supervised naltrexone has been used as an alternative to custody in opiate-misusing offenders and
studied by Brahen & Brewer, 1993. A recent systematic review of the efficacy of naltrexone maintenance treatment in opioid
dependence by Kirt Mayer et al. 2002 noted limit support for naltrexone in its findings and this treatment is generally seen as
appropriate for a minority of patients.
The Cochrane review of naltrexone maintenance for opioid dependence in January 2002 concluded `The available trials do not allow a
final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain
target groups (particularly people who are highly motivated), as has been previously described in the literature.'
There is a very limited experimental research base comparing specific psychotherapies. McLellan et al., 1994 reviewed the evidence
and concluded that `successful outcomes are related to marked and consistent differences between counsellors,' and `a study of
whether the addition of counselling improved the efficacy of methadone maintenance programmes found that the addition of basic
counselling on a weekly basis resulted in major and significant improvements'.
International literature (Gerstein D. R. et al., 1990, Kooyman M., 1993 and Hubbard, R., 1994) demonstrates improvements from
residential rehabilitation with programmes offering additional services having improved outcomes. The National Treatment Outcome
Research Study (Gossop et al. 2001) has confirmed benefits in the UK for those attending residential rehabilitation and found that
time in residential treatment is predictive of superior outcomes.
Useful general references containing more detailed references as above:
Community treatment of drug misuse: more than methadone. Nicholas Seivewright, Cambridge University Press 2000.
The task force to review services for drug misusers--report of an independent review of drug treatment services in England (DH
1997).
Methadone substitution therapy--policies and practices. Monograph series number one. Ghodse, A. M. et al. 1998. European
Collaborating Centre in Addiction Studies (ECCAS).
Subjects
Drugs; Medical treatments; Misuse; Psychiatry; Rehabilitation; Heroin; Clinical trials; Methadone; Naltrexone; Buprenorphine
Date
4 March 2003
Reference
98153; 400 c991-2W;400 c981-2W
House
House of Commons