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NETWORK A national newsletter on substance misuse management in primary care
Why are we fighting?
‘abstinence and harm reduction are not mutually exclusive, they are mutually dependent: for what
is abstinence without harm reduction alongside to scoop you up when you fall off the wagon?
And what is harm reduction, without the hope that one day you can regain your independence
and self-determination?’
Are we fighting? Since Dole and Nyswander
published their seminal work on methadone
treatment in the Journal of the American Medical
Association in 1965 there have been literally scores
of published research papers vindicating the harm
reduction approach. And the volume of evidence is
so great that some researchers argue that there is
no point doing any more: the findings in favour of
well designed and delivered methadone treatment
across all manner of hard, measurable outcomes
is incontrovertible. The evidence that these
same methadone programmes not only reduce
morbidity, mortality and criminality, but also cost-
an unusual benefit for a medical treatment – has
led the NHS and other medical systems world wide
to push massive amounts of money into funding
more methadone treatment provision.
…continued on page 3
In this issue
Are you confused about the role of ECGs for patients on high dose We asked our members for their views on the 2007 Clinical Guide-
methadone? Martin Wilkinson highlights evidence regarding the lines. Hugo Luck, National Treatment Agency Policy Manager,
risk of methadone and sudden cardiac death and gives a practical gives answers to our member’s concerns. Page 12.
guide to when an ECG should be considered. Page 4.
Are you a GP in Scotland? Get involved in the survey run by
Chris Udenze challenges the idea that being ‘colour blind’ is the The Department of General Practice and Primary Care at the Univer-
most effective way of meeting the needs of Black and Ethnic Minority sity of Aberdeen. Details on Page 13.
clients. Page 6.
Nigel Modern, Martin Wilkinson and Judith Yates reply
Lyn Matthews discusses the links between drugs and street sex to a GP who is concerned about the role of ECGs with high dose
work, and the extreme risks and stigma that sex workers face. Page methadone. Page 14.
Nigel Hewett provides some advice on how to treat a homeless
Nat Wright gives an overview of the available research and drug user. Page 15.
discusses his own experience of prescribing Subuxone, concluding
that it is a useful new option for drug treatment. Page 8.
See the bullet board on page 16 for the latest news and events.
Daren Garret asks us if there is such a thing as a hard to reach
We hope you enjoy this edition.
group, or whether it is a term that has been created by services that
have made themselves inaccessible and should be doing more to
provide treatment for all sections of the community. Page 10.
Don’t forget to become a free member and receive
Haven’t had time to read the new drug strategy? Jim Barnard
@ regular clinical and policy updates - the newsletter can
summarises the main points of the strategy and encourages us to also be emailed to you – all for free
have a closer look. Page 11. uk/membership
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