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NETWORK A national newsletter on substance misuse management in primary care
I S S U E 1 0 F E B R U A R Y 2 0 0 5
The Oral Effects Of Methadone Use
Retention in treatment
is the key
Methadone has no
signifi cant affect on dental health
See page 2
Retention in treatment is fundamental to treatment effectiveness – this is something we know primary care can
do very well. UK evidence by the National Drug Evidence Centre now demonstrates what we have known for
a long time – a key factor on treatment outcomes is avoiding early drop out and keeping patients in treatment
through their ups and downs. Retention in treatment is to become a fundamental message in treatment
effectiveness promoted by the National Treatment Agency. Primary care is ideally suited to retaining patients
as we are set up to provide longitudinal health care for local communities. Keeping patients engaged past
the fi rst few weeks and beyond is important, yet patient drop out seems to be much more down to the nature
of the service rather than the client. In a nutshell work with where each individual patient is at in a supportive,
non-punitive relationship and see relapse as part of the nature of working with substance misuse. Better in
treatment than out.
See the key points from the NTA Treatment Effectiveness paper, page 12
Crack - treatment options
in the surgery
Oral Effects of Methadone Use 2
1. Psychological interventions, such as Cognitive Behavioural Therapy (CBT)
Working with cocaine and crack users in
primary care 4-5
and Motivational Interviewing (MI) are arguably the most useful, improved by
a positive, non-punitive, relationship with a key person, such as the GP or drug
RCGP Certifi cate Part 1 update 5
Appraisal –
what on earth is it anyway? 6-7
2. Prescribed medication: never to be used outside a package of care, including
relapse prevention, is only effective for the most part in treating individual symptoms
Drug testing in the workplace 8
such as depression or insomnia (short-term only) after crack or other stimulant use
Team working with a pharmacist 9
has ceased. There is no substitute medication.
Dr Fixit on missed appointments and
3. Harm reduction: Some cocaine users for whom abstinence is not yet an option
missed pickup 10
may want help to be able to better manage their drug use. There are a number of
Dr Fixit on cocaine use with methadone 11
principles and safer practices that can be discussed with the patient in order to
reduce crack related harm.
ABC of Alcohol 11
Route of administration and dosages are the most important factors when assessing
Bulletin board 12
problematic cocaine/crack use.
Find out more on the three forms of crack treatment on pages 4-5
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