By Nicholas Seivewright
Methadone has been used effectively as a substitution agent for heroin dependency for greater than 30 years. because of its luck, different powerful tools of therapy were missed. proven as a key textual content on all treatment plans for drug misusers, neighborhood remedy of Drug Misuse: greater than Methadone has been hugely praised for its useful orientation according to a superior learn historical past. For the second one variation, the entire major evidence-based and extra pragmatic therapy ways are reviewed, not just within the administration of opiate dependence, yet around the variety of substances. It focuses largely on advancements within the previous couple of years due to coverage projects and learn findings, together with assurance of buprenorphine therapy, the systematic therapy of cocaine abuse and paintings with targeted sufferer teams. this can be of direct relevance to scientific in addition to non-medical practitioners project scientific paintings within the addictions.
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Additional info for Community Treatment of Drug Misuse: More Than Methadone 2nd Edition
By contrast, a patient on an individual treatment ‘ticket’ could face discharge from the programme for similar lack of progress, if the goal was more to encourage progressive reduction of dependency. The apt observation is made that ‘in the real world prescribing doctors are pragmatists, and the circle is squared behind the closed door of the consulting room’ (Raistrick 1997), but increasingly ‘a transparency of objectives’ is required in our understanding of the various purposes of methadone treatment.
There are signs that practitioners are 27 Section 1: Treatments concerned that ECG monitoring will be seen as required practice, with something of a consensus emerging that a cut-off point for this could be 100mg a day of methadone. The complication appears to be commoner in females, which tends to apply with most drugs that do have the side-effect of QT prolongation. Also in terms of safety considerations there must be awareness of naloxone, which reverses fatal opioid effects and which in some schemes is provided to users for when they are present at an overdose (Strang et al.
Drug testing Usually provides the main objective evidence of clinical progress Urine is the most common method, but mouth swabs ensure authenticity and hair testing much longer-term information If opportunities are sought to cut treatment costs, this is not a suitable area! Testing of opioid substitution patients should be for a range of drugs, because of the tendency to switch from heroin to other substances Safety issues There is not space here to identify all the risks in methadone treatment and the policies which are necessary to limit these, and additional reviews should be studied on the extremely important subject of methadone deaths (Webster 2005, and see below, including on the possible role of heart conduction defects).