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NETWORK A national newsletter on substance misuse management in primary care
Sex workers
patient’s health, their needs and
who needs
their choices. Importantly, getting
a better understanding and rapport
allowing for better services for the ’em?
women she sees. Ed.
As a consultant, Dr Neville Wright
How do you even ask the question?
tackles head on whether GPs are a
When I began working with street based
threat to the role of the consultant.
sex workers in South London, I tried to
He strongly argues the case for
find out what people knew. I asked GPs,
family planning clinics and other health
good primary care based care for the
professionals what their experience
majority of patients, with consultants
of working with women who worked in
playing taking on vital roles, though
this way. The answer was clear. What
not staying locked up in specialist
women? What sex workers? And most centres. Ed.
Can your patients be open enough
of the people who come to us with drug
Some of my fellow consultants were
with you about their sex work, how it
problems are men.
clearly worried after my talk at SCAN
fits with their drugs, their lifestyle and
So I needed to find another way. This
(Specialist Clinical Addiction Network)
their concerns? Dr Brenda Mosdale
time I asked women themselves what
last year about facilitating general
asks the questions about sex work,
their experiences were of drugs, sex
practitioner involvement with specialist
with a view to understanding her
…continued overleaf …continued on page 3
In this issue
level of mortality, morbidity and wasted human potential, suffered by
offenders as they leave prisons...’ A timely reminder. Pages 8 - 9
Sex workers - Can your patients be open enough with you about
Diversion - Mark Knight unravels some of the complex issues relating
their sex work? Dr Brenda Mosdale asks the questions, with a view
to diversion, supervision and drug related deaths; the multifaceted
to understanding her patient’s health, their choices and their needs.
dynamics within local illicit methadone and benzodiazepine markets,
Pages 1-2
the relationship to service provision and wide-ranging and unmet user
needs. Pages 10 -11
Consultants, who needs ‘em? As a Consultant, Dr Neville Wright
tackles head on whether GPs are a threat to the role of the consultant.
Tolerance testing troubles - The clinical consensus of the day
He strongly argues the case for good primary care based care for the
inevitably gets questioned and revised and it usually takes a few
majority of patients, with consultants not staying locked up in specialist
controversial and novel clinical perspectives to test or move the
centres. Pages 1&3
boundaries. Dr Adam Bakker raises some contentious questions and
Abstinence - Dr Gordon Morse in his second article on detoxification
stirs up debate on induction dosing and tolerance testing. Page 12
as a route to abstinence, puts a relevant focus on the individual, Suboxone – so what’s new? Dr Ford reviews the recently licensed
philosophical or even spiritual meaning for the patient. His view, that Suboxone (buprenorphine & naloxone) and how it differs from
it is the individual’s confidence and approach, rather than method per buprenorphine (Subutex). It seems the main aim is to reduce injecting
se, which is central. Page 4 misuse, but with new licenses in drug dependency not a frequent
Detoxification - Dr Daphne Rumball and Dr Kedar Kane usefully
occurrence, it’s worth taking a close look to see what is on offer.
clarify the clinical principles of detoxification and review the range of
Page 13
therapeutic approaches available. Their view, that the method chosen
Dr Fixit on sex workers who use drugs – Dr Stephen Pick complements
and principles of detoxification are central. Page 5
one of our lead articles by addressing the complex health and drugs
Improving services for substance misuse update – The NTA
problems of a young patient working the streets. Page 14
and the Healthcare Commission joint review of drug treatment
Dr Fixit on DIP – Dr Linda Harris demystifies criminal justice pathways
services nationwide. With the focus on prescribing drugs safely and
and a bit of DIP, DRR, DTTO, ASBO jargon. Page 15
appropriately, planning treatment and coordination of community
prescribing services, see what’s recommended… Page 6
We hope you enjoy this issue.
NICE update - Jim Barnard updates us on 4 recent NICE publications
relevant to the substance misuse field. Broadly they mostly confirm
Jean-Claude Barjolin
good practice, however the recommendations regarding contingency Editor
management have the potential to be controversial. Page 7
Don’t forget to become a free member and
Building bridges with the criminal justice system - Dr Mark
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Williamson, confronts the undeveloped opportunities between health, newsletter can also be emailed to you – all for
social care and security agendas citing the current ‘…unacceptable free
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