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Opiate substitution prescribing in Belfast – two year follow up study

Published online by Cambridge University Press:  13 June 2014

Ruth Collins*
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Derek Ewing
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Bob Boggs
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Noel Taggart
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Aileen Drillingcourt
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Martin Kelly
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
Diana Patterson
Affiliation:
Shaftesbury Square Hospital, 116-120 Great Victoria Street, Belfast, BT2 7PGNorthern Ireland
*
*Correspondence E-mail: RuthE.Collins@hse.ie

Abstract

Objectives: The objectives of the study were to identify the characteristics of the patients who were commenced in a newly developed opiate substitute prescribing (OSP) programme, to determine their rate of retention and to ascertain the patients' opinions of the service. We also wished to determine rates of blood borne viruses in this population.

Methods: Data were collected from three sources: the Shaftesbury Square Hospital Substitute Prescribing Database, patient charts and an anonymous user views questionnaire. We also conducted viral screening. Inclusion criteria were opiate dependence according to ICD-101 for at least one year, in individuals who were 18 years of age or older. The sample comprised the first 80 patients who attended the service, who were followed up over two years.

Results: A total of 44% of our original cohort remained engaged with the service two years after commencement. Of the remainder, 18% engaged with OSP elsewhere and 13% completed a successful detoxification from all opiate drug use. Factors which were associated with continuation in the programme were prescription of methadone (as compared with buprenorphine), female sex and higher doses of OSP. Patients reported high levels of satisfaction with the service. Of those who were tested for blood borne viruses, more than half were positive for hepatitis C infection.

Conclusions: The response to the development of the opiate substitution programme demonstrated that there was a need in the community which had not been met in the past. Service users who attended the programme reported high levels of satisfaction.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2009

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References

1.Janca, A, Ustun, TB, Van Drimmelen, J, Dittmann, V, Isaac, M. International Classification of Diseases 10. Symptom Checklist for Mental Disorders, Versions 1.1. Geneva: Division of Mental Health, World Health Organisation, 1994.Google Scholar
2.Northern Ireland Guidelines on Substitution Treatment for Opiate Dependence. Northern Ireland: Department of Health, Social Services and Public Services, 2004.Google Scholar
3.Gossop, M, Marsden, Jet al.Factors associated with abstinence, lapse or relapse to heroin use after residential treatment Addiction 2002; 97: 12591267Google ScholarPubMed
4.Smyth, BP, Barry, J, Lane, Aet al.Inpatient treatment of opiate dependence: medium-term follow up outcomes. Br J Psychiatry 2005; 187: 360365.CrossRefGoogle ScholarPubMed
5.Condelli, WS, Dunteman, GH. Exposure to methadone programs and heroin use. Am J Drug Alcohol Abuse 1993; 19: 6578.CrossRefGoogle ScholarPubMed
6.UK Audit Commission. Drug Misuse 2004: Reducing the Local Impact. London: Audit Commission, 2004.Google Scholar
7.Hammersley, R, Forsyth, A, Davies, J. The Relationship between crime and opioid use. Br J Addiction 1989; 84: 1029–104.CrossRefGoogle ScholarPubMed
8.Stewart, D, Gossop, M, Marsden, J, Rolfe, A. (2000) Drug misuse and acquisitive crime among clients recruited to NTORS. Crim Behav Mental Health 2000; 10: 1324.CrossRefGoogle Scholar
9.Gossop, M, Marsden, J, Stewart, D, Rolfe, A. Reductions in crime and drug use after treatment of addiction problems: one year follow-up outcomes. Drug Alcohol Dependence 1999; 58: 165172.CrossRefGoogle Scholar
10.Farrell, M, Gowing, L, Marsden, J, Ling, W, Ali, R. Effectiveness of drug dependence treatment in HIV prevention. Int J Drug Policy 2005; 16: 6775.CrossRefGoogle Scholar
11.Hubbard, RL, Craddock, SG, Flynn, PM, Anderson, J, Elheridge, RM. Overview of I year follow up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997; 11: 261278.CrossRefGoogle Scholar
12.Gossop, M, Marsden, J, Stewart, D, Kidd, T. The National Treatment Outcome Research Study (NTORS): 4-5 year follow-up results. Addiction 2003; 98: 291303.CrossRefGoogle ScholarPubMed
13.Festinger, D, Lamb, R, Kirby, K, Kowtz, M, Marlowe, D. Pre-treatment drop-out as a function of treatment delay and client variables. Addictive Behav 1996; 20: 111–15.CrossRefGoogle Scholar
14.Capelhorn, JRM, Bell, J. Methadone dosage and retention of patients in maintenance treatment. Med J Aust 1991; 154: 195–99.CrossRefGoogle Scholar
15.Fletcher, BW, Tims, FM, Brown, BS. Drug Abuse Treatment Outcome Study (DATOS) Treatment Evaluation Research In the United Sates. Psychol Addictive Behav 2000; 11(4): 216–29.CrossRefGoogle Scholar
16.Simpson, DDet al.Client engagement and change during drug abuse treatment. J Subst Abuse 1995; 7: 117134.CrossRefGoogle ScholarPubMed
17.Joe, GW, Simpson, DD, Hubbard, RL. Treatment predictors of tenure in methadone maintenance. J Subst Abuse 1991; 3: 7384.CrossRefGoogle ScholarPubMed
18.Simpson, D, Joe, GW, Brown, BS. Treatment retention and follow up outcomes in the Drug Abuse Treatment Outcome Study. Psychol Addictive Behav 1997; 11: 239–60.Google Scholar
19.National Treatment Agency. Models of care for the treatment of adult drug misusers. London: NTA, 2005.Google Scholar
20.Gossop, M, Marsden, J, Stewart, D, Treacy, S. Outcomes after methadone maintenance and methadone reduction treatments: two year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Dep 2001; 62: 255264.CrossRefGoogle ScholarPubMed
21.Sullivan, LE, Metzger, DS, Fudala, PJ, Fiellin, DA. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction 2005; 100(2): 150–58.CrossRefGoogle ScholarPubMed
22.Ball, J. The Effectiveness of Methadone Maintenance Treatment: Patients Programs, Services, and Outcomes. New York: Springer-Verlag, 1991.CrossRefGoogle Scholar
23.Capelhorn, JRM, Bell, J, Kleinbaum, DG, Gebski, VJ. Methadone dose and heroin use during maintenance treatment. Addiction 1993; 88(19): 6578 OSP decreases risk takingGoogle Scholar
24.Faggiano, F, Vigna-Taglianti, Fet al.Methadone maintenance at different dosages for opioid dependence. The Cochrane Database of Systematic Reviews, Issue 3, 2003.Google Scholar
25.National Treatment Agency. Methadone dose and methadone maintenance treatment. London: NTA, 2004.Google Scholar
26.Davids, E, Gastpar, M. Buprenorphine in the treatment of opioid dependence. Eur Neuropsychopharmacol 2004 May; 14(3): 209–16.CrossRefGoogle ScholarPubMed
27.Simeons, S, Matheson, C, Bond, C, Inkster, K, Ludbrook, A. The Effectiveness of community maintenance with methadone or buprenorphine for treating opiate dependence. Br J Gen Practice 2005; 55: 139146.Google Scholar
28. Statistics from the Northern Ireland Drug Misuse Database: 1 April 2006-31 March 2007. Northern Ireland Statistics and Research Agency. Dept of Health, Social Services and Public Safety Stastical Bulletin October 2007.Google Scholar
29.Northern Ireland Statistics and Research Agency. Dept of Health Social Services and Public Safety Statistical Bulletin 2007. www.dhsspsni.gov.ukGoogle Scholar
30.Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, CDSC Northern Ireland, CRDHB and the UASSG. Shooting Up. Infections among injecting drug users in the United Kingdom 2006. London: Health Protection Agency: An update October 2007.Google Scholar
31.Donmall, M, Watson, A, Millar, T, Dunn, G. Outcome of waiting lists study Waiting times for drug treatment: effects on uptake and immediate outcomes. London: NTA, 2005.Google Scholar
32.Franey, C, Ashton, M. The Grand Design Lessons from DATOS. Drug and Alcohol Findings 2002; 7: 418.Google Scholar
33.Hubbard, RL, Craddock, SG, Flynn, P, Anderson, J, Ethridge, R. Overview of one-year outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addictive Behav 1997; 11: 279293.Google Scholar
34.Fishman, J, Reynolds, T, Reidel, E. A retrospective investigation of an intensive outpatient substance abuse treatment program. Am J Drug Alcohol Abuse 1999; 76(5): 185196.CrossRefGoogle Scholar
35.Gossop, M, Marsden, J, Stewart, D, Treacy, S. A prospective study of mortality among drug users during a four year period after seeking treatment. Addiction 2002; 97: 3947CrossRefGoogle Scholar
36.National Treatment Agency for Substance Misuse. Good practice in harm reduction. London: NTA, 2008.Google Scholar
37.Hser, Y-let al.Matching clients' needs with drug treatment services. J Substance Abuse Treat 1999; 16(4): 229305.CrossRefGoogle ScholarPubMed