ACMD rejects time-limited substitution therapy

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Time limits on heroin substitution treatment such as methadone would ‘not benefit’ drug users’ recovery and would increase the possibility of relapse, according to a new report from the Advisory Council on the Misuse of Drugs (ACMD).

Imposing a time limit could also lead to other ‘significant unintended consequences’, it says, such as increased rates of overdose, blood-borne viruses and drug-related crime. The ACMD had been asked to consider whether there was a case for a maximum time limit by the Inter-Ministerial Group on Drugs.

Although there are no recommended time frames for OST maintenance in UK clinical guidelines, the issue of people being ‘parked’ on methadone has long been a controversial one. The report, however, found that while a ‘small minority’ of 10-15 per cent of service users received OST for five years or more, a larger minority ‘may not be in OST long enough to derive long-term benefit’. OST use is ‘episodic and relatively short’ for the majority of people, it says, with nearly 40 per cent stopping within six months. ‘The “being parked” analogy may not be correct,’ states the document. ‘Most people get out of the car and walk away.’

However, it was unhelpful to ‘focus on the medication alone’, stresses the report, with ‘concomitant psychosocial interventions and recovery support’ vital. OST should be seen as a ‘stepping stone’ on a path to overcoming dependency, said ACMD chair Professor Sir Les Iversen.

‘All the evidence suggests restricting access to OST leads to an increased risk of people relapsing, turning to crime to fuel their habits – and even dying from an overdose,’ said co-chair of the ACMD’s Recovery Committee, Annette Dale-Perera. ‘However, it is important to remember that medication alone will not lead to a successful recovery. OST should be delivered alongside therapy designed to change behaviour, as well as recovery interventions, to help people tackle their addiction and rebuild their lives.’

The findings were welcomed by DrugScope. ‘The notion that somebody who has been in the grip of a serious drug dependency for many years could be successfully treated to an artificial timetable has always been deeply flawed,’ said chief executive Marcus Roberts. ‘It also goes against the widely held consensus in the drug treatment and rehabilitation field that recovery should be self-determined as it is in mental health.’

However, his organisation remained concerned by anecdotal reports that some local commissioners ‘may be indicating their preference for time-limited solutions in the tendering process’, he said, adding that DrugScope would be ‘monitoring’ the situation.

Time limiting opioid substitution therapy at www.gov.uk