Misuse of drugs and other substances

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Misuse of drugs and other substances
Implementing NICE guidance
2007
NICE public health intervention guidance 4,
Clinical guidelines 51 and 52, Technology
appraisals 114 and 115
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Core principles of all NICE guidance

• Comprehensive evidence base
• Expert input
• Patient and carer involvement
• Independent advisory committees
• Genuine consultation
• Regular review
• Open and transparent process.

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Changing practice

• NICE guidance is based on the best available
  evidence
• The Department of Health asks NHS organisations
  to work towards implementing NICE guidance
• Compliance with standards monitored by the
  Healthcare Commission
• Service Improvement reviews

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Guidance this presentation covers
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PrinciplesPerson-centred care/supporting
families and carers

• People who misuse drugs should be given the same
  care, respect and privacy as any other person
• Good communication between staff and service
  users is essential and should be supported by
  evidence based written information tailored to
  the service users needs
• Families and carers
• If the service user agrees, involve families and
  carers in decisions about treatment and care
• Offer an assessment of their personal, social
  and mental health needs and provide
  information about drug misuse services

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Public health guidance Key recommendations
Community-based interventions to reduce substance
misuse among vulnerable and disadvantaged
children and young people

• Develop a strategy
• Identify those at risk
• Provide community-based interventions
• Family support
• Behavioural therapy
• Motivational interviews

NICE public health intervention guidance 4 March
2007
PHI4
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NICE Clinical Guidelines

• Drug misuse opioid detoxification (CG52)

Drug misuse psychosocial interventions (CG51)
NICE clinical guidelines 52 and 51 July 2007
CG52 51
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Key recommendationsDrug misuse opioid
detoxification

• Provide information, advice and support
• Offer choice of medication for detoxification
  (methadone/buprenorphine)
• Do not offer ultra-rapid detoxification
• Offer choice of setting for detoxification

CG52
9
Key recommendationsDrug misuse psychosocial
interventions

• Brief interventions
• Self-help
• Contingency management

CG51
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Brief interventions

• Opportunistic brief interventions focused on
  motivation should be offered to people in limited
  contact with drug services if concerns about drug
  misuse are identified

• These interventions should
• normally consist of 2 sessions each lasting 1045
  minutes
• explore ambivalence about drug use and possible
  treatment

CG51
11
Self-help

• Staff should routinely provide people who misuse
  drugs with information about self-help groups

• These groups should normally be based on 12-step
  principles for example
• Narcotics Anonymous
• Cocaine Anonymous

CG51
12
Contingency management

• Drug services should introduce contingency
  management programmes as part of the phased
  implementation programme led by the NTA

• Aim
• to reduce illicit drug use and/or promote
  engagement with services for people receiving
  methadone maintenance treatment
• harm reduction for people at risk of physical
  health problems resulting from their drug misuse

CG51
13
Principles of contingency management incentives

• The programme should offer incentives for
  example
• vouchers that can be exchanged for goods or
  services of the service users choice, or
• privileges such as take-home methadone doses
• contingent on each presentation of a drug-
  negative test
• If vouchers are used, they should have monetary
  values that start in the region of 2 and
  increase with each additional, continuous period
  of abstinence

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Principles of contingency management to improve
physical healthcare

• People at risk of physical health problems
  resulting from their drug misuse, material
  incentives should be considered to encourage harm
  reduction
  (e.g.
  shopping vouchers of up to 10 in value)
• Incentives should be offered on a one-off basis
  or over a limited duration, contingent on
  concordance with or completion of each
  intervention, in particular for
• hepatitis B/C and HIV testing,
• hepatitis B immunisation,
• tuberculosis testing

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Other psychosocial interventions

• Behavioural couples therapy
• Cognitive behavioural therapy
• Psychodynamic therapy

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Methadone and buprenorphine for the management of
opioid dependence (TA114)

• Are recommended as options for maintenance
  therapy in the management of opioid dependence
• The choice of drug should be made on a case by
  case basis - methadone should where possible be
  first choice
• Administration should be daily and under
  supervision for at least the first 3 months

TA114
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Naltrexone for the management of
opioid dependence (TA115)

• Is recommended as a treatment option in
  detoxified formerly opioid-dependent people
• Should only be administered under adequate
  supervision and as part of a programme of
  supportive care
• The effectiveness of using naltrexone as a
  treatment should be reviewed regularly

TA115