Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales

Strang, John; Sheridan, Janie; Barber, Nick

doi:10.1136/bmj.313.7052.270

Cited by 140 publications

(98 citation statements)

References 6 publications

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“…In several countries, pharmacies are involved in syringe exchange, distributing or selling low price kits containing injecting equipment, providing treatment for addiction, dispensing methadone, supervising methadone consumption, and providing information on drug misuse and HIV prevention. 12,13,[23][24][25][26] Pharmacists in our study believed that HIV/AIDS was a serious social and public health issue; they valued the work of SEPs but held a strongly negative position toward IDUs and against the idea of involving pharmacies in actual harm reduction service delivery. Resistance was explained by concerns that IDUs would steal from the pharmacy, endanger staff, and scare away other customers; these reactions are similar to those seen in other studies.…”

Section: Discussionmentioning

confidence: 74%

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

et al. 2009

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Despite the high number of injecting drug users (IDUs) in Estonia, little is known about involving pharmacies into human immunodeficiency virus (HIV) prevention activities and potential barriers. Similarly, in other Eastern European countries, there is a need for additional sources for clean syringes besides syringe exchange programmes (SEPs), but data on current practices relating to pharmacists' role in harm reduction strategies is scant. Involving pharmacies is especially important for several reasons: they have extended hours of operation and convenient locations compared to SEPs, may provide access for IDUs who have avoided SEPs, and are a trusted health resource in the community. We conducted a series of focus groups with pharmacists and IDUs in Tallinn, Estonia, to explore their attitudes toward the role of pharmacists in HIV prevention activities for IDUs. Many, but not all, pharmacists reported a readiness to sell syringes to IDUs to help prevent HIV transmission. However, negative attitudes toward IDUs in general and syringe sales to them specifically were identified as important factors restricting such sales. The idea of free distribution of clean syringes or other injecting equipment and disposal of used syringes in pharmacies elicited strong resistance. IDUs stated that pharmacies were convenient for acquiring syringes due to their extended opening hours and local distribution. IDUs were positive toward pharmacies, although they were aware of stigma from pharmacists and other customers. They also emphasized the need for distilled water and other injection paraphernalia. In conclusion, there are no formal or legislative obstacles for providing HIV prevention services for IDUs at pharmacies. Addressing negative attitudes through educational courses and involving pharmacists willing to be public health educators in high drug use areas would improve access for HIV prevention services for IDUs.

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Section: Discussionmentioning

confidence: 74%

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

et al. 2009

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“…The Task Force identified the markedly higher level (compared with other countries) of methadone as the drug reported in drug overdose deaths, as later reported by Hall, Lynskey & Degenhardt [23], and also commissioned work by Janie Sheridan and myself which established the lack of supervision of consumption of methadone in England [24]. As a direct result, through new national guidelines on the management of drug dependence [21], we were able to recommend widespread introduction of supervised dosing of prescribed methadone during the early months of maintenance treatment.…”

Section: Medications Which Heal But Also Harm-a Complex Relationshipmentioning

confidence: 92%

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

Strang

2015

Addiction

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Aims To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome. Methods Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation. Results Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations.Conclusions Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.

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“…90 Our analysis has shown that expansion of methadone maintenance programs is a cost-effective use of health care resources and suggests that these barriers deny access to a cost-effective therapy. In addition, alternatives to methadone maintenance, including medical models of dispensing methadone, 91 the use of levo-α− acetylmethadol (LAAM), 92 and drugs such as buprenorphine, 93 may be cost-effective. Our analysis had several limitations.…”

Section: Discussionmentioning

confidence: 99%

HIV transmission and the cost-effectiveness of methadone maintenance

Zaric¹,

Barnett²,

Brandeau³

2000

Am J Public Health

196

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OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.

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Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales

Cited by 140 publications

References 6 publications

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths

HIV transmission and the cost-effectiveness of methadone maintenance

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