Expert group calls for focus on abstinence

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Substitute prescribing ‘not an end in itself’, says group chaired by Prof John Strang.

Service users should not be ‘parked indefinitely’ on substitute medication and all prescribing treatments need to be regularly reviewed, according to the final report from the expert group chaired by Professor John Strang of the National Addiction Centre. However the group has rejected the idea of time limits on treatment, warning that this could increase rates of overdose, crime and blood-borne virus transmission as well as damage people’s chances of recovery.

The cross-sectoral group, which delivered its interim report last year (DDN, August 2011, page 5) includes chief executives Viv Evans, Karen Biggs, Noreen Oliver and Ian Wardle, service user representatives Peter McDermott of The Alliance and Jason Gough, GPs Gordon Morse and Roy Robertson, psychiatrists Alison Battersby, Michael Kelleher and Ed Day and academics David Best, Neil McKeganey and Alex Copello, as well as psychologists, nurses, commissioners, service directors and others.

Although clearly stating that opioid substitution therapy is effective, Medications in recovery: re-orienting drug dependence treatment says that there needs to be immediate action to ensure it is ‘always delivered in line with clinical guidance’. Professionals should review their patients to ‘ensure they are working to achieve abstinence from problem drugs’, it says, as well as integrate services with mutual aid groups, employment, housing and other support agencies and make sure that treatment programmes are dynamic and ‘support recovery’.

The report acknowledges that behaviour change depends on a ‘range of internal and external resources’ that many people may not have, but says that there is a culture of commissioning and practice that does not ‘give sufficient priority to the desire of individuals to overcome their dependence on drugs’, adding that it is not acceptable to leave people on OST ‘without actively supporting their recovery and regularly reviewing the benefits of their treatment’.

‘Overcoming heroin addiction is often very difficult, but with the right support, more people can and will recover from dependence,’ said Professor Strang. ‘Substitute prescribing has an important contribution to make to recovery-orientated drug treatment, but it is not an end in itself. More needs to be done by all of us in the health profession to ensure that users are signposted, supported and encouraged to overcome dependence whenever possible, and to reintegrate into society.’ ‘Our ambition is for the English treatment system to become a world leader in delivering recovery outcomes, ensuring every individual in treatment is given the opportunity to leave addiction behind,’ said NTA chief executive Paul Hayes.

Report at www.nta.nhs.uk Prof John Strang will be explaining the group’s findings in August’s issue of DDN.