Drug misuse and dependence: UK guidelines on clinical management

The working group updating the 2007 UK national clinical guidelines on drug treatment has published some preliminary advice on naloxone before addressing its supply and use more fully in the published update in 2016. The advice covers naloxone dosing in overdose situations, take-home naloxone products that can be supplied and training that should be provided. An open letter from Professor John Strang, chair of the clinical guidelines update working group. Naloxone and its use: Across Europe, illicit opioid users are 10 times more likely to die than their peers of the same age group and gender, and 6,100 deaths were attributed directly to opioid overdose in 2012. Naloxone is a potentially life-saving medicine when used in settings associated with opiate misuse and overdose. There is evidence that take-home naloxone given to service users, and training family members or peers in how to administer naloxone, can be effective in reversing heroin overdoses. Its legal status means that anyone can administer naloxone for the purpose of saving a life, and it has been supplied by some drug treatment services since 2005. However naloxone is only licensed for use in injectable form and remains a prescription-only medicine. This means that at present it can only be distributed to patients with a prescription or via an alternative mechanism (patient group direction (PGD) or patient specific direction (PSD)). Naloxone is an opioid/opiate antagonist and is already licensed for use in: 1. complete or partial reversal of central nervous system depression and especially respiratory depression, caused by natural or synthetic opioids; and 2. treatment of suspected acute opioid overdose or intoxication. An NHS England Patient Safety Alert in November 2014 highlighted risks associated with the use of naloxone in patients where it is not indicated, or in larger than recommended doses......

[1]  J. Strang,et al.  Spice and all things nasty: the challenge of synthetic cannabinoids , 2016, British Medical Journal.

[2]  J. Strang,et al.  Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures? , 2016, Addiction.

[3]  P. Friedmann,et al.  Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders. , 2016, The New England journal of medicine.

[4]  A. Bretteville-Jensen,et al.  Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study. , 2015, Addiction.

[5]  J. Bell,et al.  Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction , 2015, British Journal of Psychiatry.

[6]  S. Bird,et al.  National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009 , 2015, Drug and alcohol dependence.

[7]  N. Bhat,et al.  Effect of Anti-Smoking Legislation in Public Places , 2015, Addiction & health.

[8]  N. Wright,et al.  Comparative prices of diverted buprenorphine/naloxone and buprenorphine in a UK prison setting: a cross-sectional survey of drug using prisoners. , 2014, Drug and alcohol dependence.

[9]  T. Dobbins,et al.  The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. , 2014, Addiction.

[10]  F. Schifano.  Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern? , 2014, CNS Drugs.

[11]  T. Dobbins,et al.  Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study , 2014, BMJ Open.

[12]  R. Hamilton,et al.  Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy , 2013, British Journal of Ophthalmology.

[13]  M. Cary,et al.  Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction , 2013, British Journal of Psychiatry.

[14]  S. Hutchinson,et al.  Anthrax infection among heroin users in Scotland during 2009-2010: a case-control study by linkage to a national drug treatment database. , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  Nicholas Moore,et al.  Road traffic crashes and prescribed methadone and buprenorphine: a French registry-based case-control study. , 2012, Drug and alcohol dependence.

[16]  D. Nutt,et al.  BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP , 2012, Journal of psychopharmacology.

[17]  L. Møller,et al.  The effectiveness of opioid maintenance treatment in prison settings: a systematic review. , 2012, Addiction.

[18]  M. Ferri,et al.  Heroin maintenance for chronic heroin-dependent individuals. , 2011, The Cochrane database of systematic reviews.

[19]  J. Parry,et al.  The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. , 2011, Addiction.

[20]  F. Schifano,et al.  Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997-2007. , 2011, British journal of clinical pharmacology.

[21]  V. Love,et al.  Neonatal and maternal outcomes following maternal use of buprenorphine or methadone during pregnancy: findings of a retrospective audit. , 2011, Women and birth : journal of the Australian College of Midwives.

[22]  A. Pharris,et al.  Prevention and control of infectious diseases among people who inject drugs , 2011 .

[23]  H. Jones,et al.  Neonatal abstinence syndrome after methadone or buprenorphine exposure. , 2010, The New England journal of medicine.

[24]  W. Hall,et al.  Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): analyses using OD4 index in England and Scotland , 2010, BMJ : British Medical Journal.

[25]  D. Best,et al.  New estimates of the number of children living with substance misusing parents: results from UK national household surveys , 2009, BMC public health.

[26]  M. Lader,et al.  Withdrawing Benzodiazepines in Primary Care , 2009, CNS Drugs.

[27]  D. Kavanagh,et al.  Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. , 2009, Addiction.

[28]  T. Dellit,et al.  Drug users seeking emergency care for soft tissue infection at high risk for subsequent hospitalization and death. , 2008, Journal of studies on alcohol and drugs.

[29]  J. Strang,et al.  Drugs and pregnancy--outcomes of women engaged with a specialist perinatal outreach addictions service. , 2008, Drug and alcohol review.

[30]  K. Thau,et al.  Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates. , 2008, Addiction.

[31]  M. Farrell,et al.  Acute risk of drug-related death among newly released prisoners in England and Wales. , 2008, Addiction.

[32]  M. Krausz,et al.  Heroin-assisted treatment for opioid dependence: randomised controlled trial. , 2007, The British journal of psychiatry : the journal of mental science.

[33]  K. Wolff,et al.  Excessive alcohol consumption is associated with reduced quality of life among methadone patients. , 2007, Addiction.

[34]  G. Raab,et al.  Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: A randomized controlled trial. , 2006, Addiction.

[35]  K. Humphreys,et al.  Predictors of retention in methadone programs: a signal detection analysis. , 2006, Drug and alcohol dependence.

[36]  E. Boyko,et al.  Type and location of injection drug use-related soft tissue infections predict hospitalization , 2003, Journal of Urban Health.

[37]  W. van den Brink,et al.  Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials , 2003, BMJ : British Medical Journal.

[38]  F. Faggiano,et al.  Methadone maintenance at different dosages for opioid dependence. , 2003, The Cochrane database of systematic reviews.

[39]  D. Fishbain,et al.  Are opioid-dependent/tolerant patients impaired in driving-related skills? A structured evidence-based review. , 2003, Journal of pain and symptom management.

[40]  M. Farrell,et al.  D ru g - related mortality among newly released offenders , 2003 .

[41]  R P Mattick,et al.  Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. , 2009, The Cochrane database of systematic reviews.

[42]  J. Salmon,et al.  Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users. , 2002, Journal of medical microbiology.

[43]  M. Battegay,et al.  Infections requiring hospitalization of injection drug users who participated in an injection opiate maintenance program. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[44]  C. Archie.  Methadone in the management of narcotic addiction in pregnancy. , 1998, Current opinion in obstetrics & gynecology.

[45]  L. Finnegan,et al.  Children of maternal substance misusers , 1997 .

[46]  D. Thomas,et al.  Neonatal Abstinence Syndrome , 2014, Pediatrics.

[47]  M. Strauss,et al.  A STUDY OF FACTORS THAT INFLUENCE THE SEVERITY OF NEONATAL NARCOTIC WITHDRAWAL , 1974, Pediatric Research.