TOUGH LINE ON DRUG INJECTION PRINCIPLES

Tight restrictions have been set in the first official guidance on
prescription of injectable heroin and methadone for hard-core drug users.

The potentially controversial guidance was issued by the national treatment
agency (NTA) last Friday, as the government reshuffle dominated news
agendas. But the guidelines - for specialist doctors - are worded with
painstaking care and stress repeatedly the limited nature of their application.

"The message for specialist clinicians is that, yes, injectable heroin and
injectable methadone have a role to play in the treatment of drug misuse -
but it's a limited role and one that needs to be developed very carefully,"
says John Strang, chair of the NTA's heroin expert group and head of the
National Addiction Centre.

The guidance was foreshadowed last month by David Blunkett, home secretary,
who accepted that "radical thinking" was needed to engage hardened drug
takers. But he said he expected no dramatic increase in the number of
patients prescribed heroin - currently just 440.

Although heroin prescription for oral use "is and will remain" the most
clinically appropriate form, the NTA asserts, injectable medication "may be
appropriate for a minority who fail to benefit from oral maintenance
programmes".

Injectable medication is "potentially more risky both for the patient and
the public and should only be considered by a specialist and if there are
adequate services in place, including supervised consumption of medication
until the patient has stabilised", the NTA says.

The guidance lays down eight principles to be observed in connection with
any prescription of injectable heroin or methadone. These include provision
of an integrated care package for patients, so that injection is not
sanctioned in isolation, and that other options are explored fully.
Priority should be given to improving the effectiveness of prescription for
oral use, the guidelines say.

On monitoring of injection, the guidance states: "Injectable drugs may
present more risk of overdose than oral preparations, and have a greater
street value on illicit markets, and hence may require greater levels of
supervision."

Paul Hayes, NTA chief executive, says the guidance represents only part of
an overall strategy to improve treatment for drug users. "Treatment is not
just about prescribing a substitute drug. It's about the full range of
services - including counselling, in-patient care, prescribing and aftercare."

Roger Howard, chief executive of charity Drugscope, says: "We welcome the
NTA guidelines on heroin prescription and hope that they will lead to the
situation found in other countries where, when other treatments have
failed, there is an increase in users potentially being prescribed heroin."

The guidance is at: www.nta.nhs.uk