One Year's Experience in a Drug-Dependence Clinic

Gardner, R; Connell, P. H.

doi:10.1016/s0140-6736(70)90067-x

Cited by 26 publications

(8 citation statements)

References 14 publications

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“…Rather, it would appear that there was a gradual process of change in prescribing practice over the 15-year period covered by this article, with different discernable stages to these changes-at least for the clinic whose data we examined. This formulation of more gradual change would be compatible with the sparse data reported by others, such as snapshot descriptions of clinic practice at the time of their original establishment (Bewley et al, 1971;Gardner and Connell, 1970;Willis, 1969) and later from the middle years Connell, 1975), the report of the internal doubts and debates among the London clinics in this middle period (Mitcheson and Hartnoll, 1978), and the perspectives of the addict patients themselves (described by Stimson and Oppenheimer, 1982), many of whom were interviewed about their experiences of treatment from the clinics over these years.…”

Section: Discussionsupporting

confidence: 69%

“…Some very early accounts (Bewley and Fleminger, 1970;Blumberg et al, 1974;Gardner and Connell, 1970;Willis, 1969) and commentaries on the new clinic system Bewley et al, 1971;Connell, 1975;Glatt, 1972) were published. Additionally, an overview later became available from recovered graphs of pan-London patterns of prescribing over this period (Mitcheson, 2005).…”

Section: Introductionmentioning

confidence: 99%

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Heroin and Methadone Prescriptions From a London Drug Clinic Over the First 15 Years of Operation (1968–1983): Old Records Examined

Strang

Sheridan

2006

Substance Use & Misuse

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We charted changes in the prescriptions issued to opiate addicts in treatment at a London clinic over the first 15 years of operation of one of the new National Health Service (NHS) drug clinics established in 1968. Having located the original handwritten ledger records of prescriptions issued by the drug addict treatment clinic, an SPSS data file was created of the prescriptions given to each of the clinic patients each month over the period 1968-1983 to permit examination of changes over this 15-year period in the drugs prescribed (e.g., heroin, methadone), the form (e.g., injectable or oral), the daily doses, and the extent of multiple items for single patients (e.g., both injectable ampule and oral forms). For each month, a list was available of all current patients detailing which drug(s) they had received during that month, in what form(s) and what dose(s). These items were the basic units of study. We report changes over the 15-year period for which the data were available. For the first 5 years, more than half of the prescriptions were for heroin (diamorphine hydrochloride), with the remainder of the prescriptions mostly comprising oral methadone. After 1973, methadone ampules for injection were increasingly commonly prescribed and thereafter remained at about a quarter of the prescriptions for the remaining 10 years for which data are available, whereas heroin prescriptions declined over the mid-1970s to only 20%. From 1973 onward, oral methadone was increasingly prescribed, rising from approximately one third of prescriptions in the early 1970s to more than two thirds by the early 1980s. Individual patients often received more than one drug or form of drug: From 1969 onward, oral methadone was commonly prescribed as a supplement to heroin prescriptions. This same practice was widespread with prescriptions for methadone ampules prescribed as a supplement to heroin prescriptions. Daily doses of heroin were at a mean of from 160 to 540 mg, in contrast with means of 20 to 40 mg and 25 to 50 mg daily for the injectable methadone ampules and the oral methadone solution, respectively. Major changes occurred in the prescribing practices of this London drug clinic over the first 15 years of operation of the new NHS clinics. However, these changes did not occur overnight and can be seen to have been gradual evolutions of practice with the preservation of heroin prescription through the first 5 years and the subsequent move to increased prescribing of injectable methadone, with both these practices being overtaken by the subsequent increased prominence of oral methadone syrup as the main drug prescribed. Reference to the original records reveals a more interesting picture than might be evident from the potentially selective recall of contemporary or historical commentators.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Heroin and Methadone Prescriptions From a London Drug Clinic Over the First 15 Years of Operation (1968–1983): Old Records Examined

Strang

Sheridan

2006

Substance Use & Misuse

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“…Connell [28] attributed the need for these con trols not only to the excessive prescribing of a small num ber of doctors which had attracted such attention, but also to the potential for abuse of the system at its weakest points: 'all professional classes contain weaker brethren' [28,29]. The new special drug treatment centres were established (mainly across London) in 1968, along the lines previously described [25,30]. The new notification system was introduced in 1968 as a statutory obligation on all doctors to notify cases of addiction to specified drugs (most of the opiates and cocaine).…”

Section: The Emergence Of the First Specialist Drug Treatment Centresmentioning

confidence: 99%

Heroin Prescribing in the British System: Historical Review

Strang¹,

Gossop²

1996

Eur Addict Res

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Heroin has been prescribed in the UK in the treatment of addiction for nearly a century. However, despite international fascination with this practice, it is only rarely employed by doctors in the UK – to less than 2% of addicts in treatment in the mid-1990s. The history of changing professional attitudes to, and use of, heroin prescribing over the 20th century is described. Particular attention is paid to the period since the mid-1960s when a new modern-day drug problem emerged with young disenfranchised heroin injectors appearing in Britain for the first time, and to the post-HIV debate with its wide public health consideration, the urgent need to reduce needle-sharing and the accumulating evidence of multiple benefits from oral methadone maintenance programmes. New data on the extent of heroin prescribing in the UK in the mid-1990s are summarised.

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“…For instance, Gardner and Connell [16] reported on 107 opioid addicts who had been patients at a drug dependence clinic between March 1968 and February 1969. Based on addiction severity at treatment onset, patients were divided into 5 groups according to the doses consumed before therapy, with dosages ranging from 60 to 610 mg. Two patients with very high doses of 1,200 mg and 1,500 mg were included.…”

Section: Dosagesmentioning

confidence: 99%

Dosage Regimes in the Prescription of Heroin and Other Narcotics to Chronic Opioid Addicts in Switzerland – Swiss National Cohort Study

et al. 2003

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Aims: Within the guidelines of the research programme on medical prescription of narcotics for opioid addicts (PROVE), heroin, morphine, and methadone were prescribed to heavily opioid addicted individuals in Switzerland since 1994. This contribution analyses the course of dose levels during the treatment period. Design: Naturalistic description of consumed dosages per day and month. Setting and Participants: The study describes the dosages prescribed to all individuals who began outpatient treatment in the PROVE programme in Switzerland between 1994 and 1996. Measurements: Consumed amount of narcotics per day and the course of dosage of injectable heroin in different treatment regimes. Findings: Heroin was the most frequently prescribed narcotic. Of all consumption days, heroin had been applied in 77% as injection and in 9% in a smokeable form. The mean daily dosage was 474 mg for intravenous application and 993 mg for the smokeable form. Second most frequent was the prescription of oral methadone, in most cases in combination with heroin. The mean amount of daily consumption of oral methadone was 53 mg. There were dosage differences between treatment regimes. During the course of treatment the mean dosage for injectable heroin per day decreased significantly and, depending on the treatment regime, almost linearly. Conclusions: The significance of heroin dosages in heroin-assisted therapy for treatment outcome should be further explored, especially in the light of the markedly higher dosages in Switzerland compared to the UK. During the treatment period, dosages did not increase but generally decreased, indicating no further increase in tolerance.

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One Year's Experience in a Drug-Dependence Clinic

Cited by 26 publications

References 14 publications

Heroin and Methadone Prescriptions From a London Drug Clinic Over the First 15 Years of Operation (1968–1983): Old Records Examined

Heroin and Methadone Prescriptions From a London Drug Clinic Over the First 15 Years of Operation (1968–1983): Old Records Examined

Heroin Prescribing in the British System: Historical Review

Dosage Regimes in the Prescription of Heroin and Other Narcotics to Chronic Opioid Addicts in Switzerland – Swiss National Cohort Study

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