Glasgow Addiction Services

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Dr Kennedy Roberts Lead Specialist Senior
Medical Officer Glasgow Addiction Services
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Bless the Lord for giving opium to the human
race.

• Quotation from Sir Thomas Sydenham. Philosopher
  and philanthropist 1624-1689
• Medical studies were interrupted but became
  founder of British Clinical Practice

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All substances are toxic, it is only the dose
that makes something not a poison
Paracelsus
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Ive never had a problem with drugs Ive had
problems with the police
Keith Richards
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Where do drug addicts come from?Venus/Mars or
Outer Space

• From deprived areas
• From families with drug or alcohol misuse
• From families who havent had employment for
  perhaps 2 previous generations

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Where do drug addicts come from?Venus/Mars or
Outer Space

• From backgrounds of boredom, low self-esteem,
  poor educational achievements.
• From areas where drugs are in ready supply.

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Drug Misusers Are

• Responsible for 40 of all acquisitive crime
• Committing an average of 26 crimes per month
  each.

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Historical Approaches

• 1960s Hedonistic Drug Misuse and prescription
  drug misuse
• 1970-1980 Prescription drug misuse giving way to
  increase in illicit drugs and increase in IV
  users Harm reduction and control of Blood
  Borne Viruses
• 1990s Appearance of a proactive rather than
  reactive approach
• 2006 Multidisciplinary and multi-agency working
  becoming reality?

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Approaches based on
Scientific opinion (may change) Advice to the
Government by pressure, and self help
groups Public opinion Political policy, and
enforcement of Others
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Relative Costs

• HAT Swiss Experience (Gutzwiller and Steffen ,
  2000) 8,030
• Netherlands (van den Brink , 2002) between 9,775
  and 17,1079
• Average UK costs of methadone programme 2,800.
• The range in developed countries is between
  1,320 and3,500. (Centre for Addiction and
  Mental Health,2002 Ministry of
  Health,1996,National Evaluation Data
  Services,1999)

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Heroin Assisted Treatment

• It is not clear who does best on treatment
• There is no evidence that the current heroin
  prescribing undercuts the illicit market or
  reduces drug scenes.
• Illicit use of heroin and other drugs decreases
  but it is not eliminated
• Crime is reduced but not eliminated
• However may be cost beneficial in terms of
  reduced crime
• However it is uncertain if it is more
  cost-effective than methadone

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Doctor or Drug Dealer?

• Medical model requires compliance and commitment
  from the patient as in all other medical
  conditions.
• Diet in many diseases
• Lifestyle restrictions
• Abstinence in alcohol, or do we just give alcohol
  to non compliant patients? ( has been done
  successfully)
• Is the game a bogey?

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Drug Addiction

• Physical Health - BBVs, endocarditis, abscesses,
  vascular problems, diet, dental problems,
  pregnancy etc.
• Mental health, sleep disturbance, anxiety,
  depression, low self esteem ,deliberate self harm
  and suicide.
• Social - the destruction of self, family life and
  community.
• Criminal and anti-social behaviour.

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Drug Addiction

• Probably the most destructive health and social
  problem facing Scotland.
• Relapsing and chronic condition with no one
  discipline having a cure.
• Opioid users change with time and treatment.
• Treatment works.
• Let us consider adding a range of treatment
  options in Glasgow we are rolling out
  buprenorphine- and let there be reason and
  debate.
• We need to decide on emphasis most certainly
  but let us not be exclusive

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