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In light of the investigation by the General Medical Council on prescribing practices at a well‐respected treatment centre, we present the case for slow detoxification.

The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from an unsuccessful randomised controlled trial. The first sample comprised 68 participants who were randomly allocated to naltrexone treatment. The second sample comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.

The objective of this study was to examine practices and policies in place for the provision of substitution treatment in prison in 18 European countries. Methodology. Across the 15 European member states (prior to 1 May 2004) and Czech Republic, Poland and Slovenia, interviews with ministerial representatives, professionals (i.e. service providers and security officials) working in prisons, and a total of 33 focus groups with a total of 132 male and 52 female prisoners were conducted. Results. Although constraints of access to substitution treatment for specific target groups only (e.g. HIV‐positive opiate users) have largely vanished, substitution treatment is now offered to a broad cross‐section of prisoners. The provision of this treatment still lags behind the standards of substitution treatment in the community (regarding access and continuity). In most countries, this form of therapy is most likely to be discontinued when entering prison. A treatment gap persists between prisoners requiring substitution maintenance treatment and those receiving it. Heterogeneous and inconsistent regulations and treatment modalities appear throughout Europe, sometimes within the same country or region. The concrete provision practice of substitution treatment in prison varies from one country to the other, from one prison to the other, within a medical team, and even from one doctor to another. Although psychosocial care was seen as a valuable additional and necessary part of the treatment to support the medical part of the substitution treatment in prison, it was found that such support was rarely provided. Compared to previous research, this study illustrates that the scope of substitution treatment has extended considerably across Europe. Across the board, a consensus surrounding the need to continue substitution treatment that had already been started in the community was apparent.

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

The World Health Organisation and the International Council of Nurses (WHO/ICN, 1991) broadly define addiction nurses' roles into eight domains that suggest a set of core competencies required to work effectively within this challenging area of nurse practice. This paper reports on a survey of addiction centres across eight European countries. The survey explored the role of the nurse specifically within methadone substitution therapy programmes, with the intention of mapping perceived key roles against the ICN/WHO domains. While many of WHO/ICN domains were evident (provider of care; educator; counsellor; advocate) significant limitations were revealed in other domains.

The purpose of this paper is to explore how injecting opiate users on a methadone treatment programme experience stigma as drug addicts, and as service users in health care and pharmacy settings. In particular the paper explores the rationale for injecting drugs, which the paper is argued to create the conditions for experiencing shame at the micro interactional level, influenced by macro institutional factors. The paper links this issue of being an injecting drug user in treatment to question whether the definition of recovery as “drug free” in the Scottish drug policy document The Road to Recovery (2008) creates the potential for stigma of service users receiving methadone maintenance treatment.

In all, 14 participants, all of whom identified themselves as problem intravenous users of drugs, were recruited from three voluntary sector (third sector) treatment agencies in Scotland. Participants took part in semi-structured interviews; these were recorded, transcribed and qualitatively analysed thematically.

Participants describe feelings of stigma in relation to their drug taking as problem users. Their experiences as recovering opiate injectors raises further challenges in distancing themselves from stigmatised addict identities.

Reasons for injecting rather than smoking heroin were principally financially challenging a widely held belief that users inject primarily for pleasure, which is argued as increasing the potential for stigma. Shame and perceived discrimination was documented before and during drug treatment.

Interviews with pregnant substance misusing women and women who had given birth in the previous two years suggest that they are engaged in a process of managing spoiled identities in order to present themselves as committed and motivated mothers. The work they engage in involves presenting themselves as regulated consumers by keeping to substitute prescribing regimes, keeping appointments with a multitude of agencies and aligning themselves with a normalised discourse of motherhood. Interview accounts emphasise the importance of caring networks in personal lives and in the service with which they are engaging.

The purpose of this paper is to identify the probability of the occurrence of an analgesic medication injury when controlling for potential risk factors, as well as gain a better understanding of which risk factors appear more problematic.

Cross‐sectional retrospective review of 2004 Centers for Medicare and Medicaid Service Medicaid Pharmacy claims data. Logistic regression analysis performed to examine the risk of injury‐related emergency room (ER) visits following the use of analgesics controlling for potential risk factors.

Methadone, an agent to treat severe pain, and propoxyphene, an agent to treat non‐severe pain, are problematic opioids in the elderly. White origin, male gender, and increased disease burden are potential risk factors influencing injury‐related ER visits for elderly analgesic recipients. Increased age in the elderly is a potential risk factor for severe pain analgesics; decreased age for non‐severe pain analgesics.

The study uses administrative data which, by its nature, makes conducting outcomes research on inappropriate medication use problematic. A number of confounders are present.

Appropriate drug therapy in an elderly patient is complicated by age‐related changes in pharmacokinetics as well as chronic disorders that affect drug response. Knowing of additional risk factors that may place the patient at greater odds of having an adverse outcome should improve prescribing practices.

The findings add to the literature by identifying problematic risk factors associated with injury among elderly recipients of analgesics.

We investigate the relationships between violence, drug use and methadone maintenance treatment (MMT) for women injection drug users (IDUs). The data presented here come from a longitudinal study of 233 IDUs both in and out of MMT in the San Francisco Bay Area. Each was interviewed five times over a period of three years, both qualitatively and quantitatively. Using grounded theory principals, we analyze 55 women's accounts of violence. We find that violence acts both as a barrier to entry to treatment and to successful treatment outcomes. Violence is related to drug use and treatment in several ways, primarily in that violence is a traumatic experience to which some women respond by using drugs. Violence may include forced drug use or methadone diversion. Violence may cause women to interrupt or postpone treatment. Finally, two women experienced violence from their treatment providers, which forced them to leave their programs. We suggest that in order to maximize successful treatment outcomes and reduce drug‐related harm for women, violence must be addressed in the treatment process.

The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.

A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one‐year periods, by cross‐sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in‐patient.

There were significant increases in: referral to the specialist service whilst an in‐patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significant decreases in the history documented for opiate withdrawal symptoms and alcohol consumption.

The method used may not reflect actual clinical practice, only captures opiate‐dependent patients prescribed methadone and does not establish the extent of awareness of the new guideline.

The paper identifies a variation in clinical practice of management of patients with opiate dependence in the general hospital. Though there were some significant improvements, further improvement and continual evaluation are needed.

The paper identifies the need to study how co‐morbid opiate dependence is managed in the acute hospital setting.