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Drug misuse

UK drug advisory council warns against limiting duration of methadone therapy

Experts think a reduction in opioid substitution therapy could trigger more drug-related crime and increase the number of HIV infections.

Government drug advisers warn against suggestion by ministers to limit methadone therapy for heroin users, pictured

Source: Janine Wiedel Photolibrary / Alamy

There are no national recommended time frames for opioid substitution therapy in the UK

Government drug advisers have rejected a proposal by government ministers to impose a time limit on prescribing methadone to heroin addicts. 

The Advisory Council on the Misuse of Drugs (ACMD) has written to the Minister of State for Crime Prevention at the Home Office Lynne Featherstone to say that the evidence “strongly suggests” that introducing an across-the-board time limit would result in most heroin users relapsing. 

The letter follows a review of evidence requested by UK government ministers to discover whether heroin addicts are put on opioid substitution therapy (OST) for longer than is “necessary or desirable”. 

“Opioid substitution therapy can be a very helpful part of treatment and recovery for those with heroin dependence,” said the letter. “But it is unhelpful to focus on the medication alone.” 

A reduction could also trigger more drug-related crime and boost the number of new cases of HIV infection and hepatitis among the drug misuse community. 

The committee points out that there are no national recommended time frames for OST maintenance in the UK but that there is strong international evidence that increased lengths of time lead to better outcomes. It says there is additional evidence that limiting OST would have serious negative unintended consequences and that there is little evidence that this approach would be beneficial. 

“Rates of relapse are high when heroin users voluntarily detoxify and complete OST, illustrating the difficult, relapsing nature of heroin addiction and the challenge we face in enabling heroin users to achieve a range of recovery outcomes — particularly with our ageing heroin population with limited recovery capital,” the ACMD’s recovery committee report adds.

“We are concerned that more individuals appear to be in OST for too short a time to benefit than are in OST for more than five years. For those who need OST, access should not be limited, but rather enhanced.” 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20067125

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