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GPs over-reliant on substitute drugs in treatment of heroin users, report says

GPs need to take a broader approach to help heroin addicts overcome addition, having become over-reliant on substitute drugs, according to a new report.

The two-year inquiry – led by National Addiction Centre director Professor John Strang – drew on evidence from GPs, psychiatrists, psychologists, nurses, service users and providers and looked at best practice to help heroin addicts recover from substance misuse. It reported a culture within the NHS of parking these patients on substitute drugs, such as methadone, indefinitely.

The report calls for GPs to review all existing patients to ensure they are actively trying to give up addiction, that treatment programmes do support recovery and that they are working together with other recovery support functions such as employment services and housing agencies to aid recovery.

The research group was set up in response to the coalition Government's 2010 Drug Strategy, which said too many people risked remaining on a substitute prescription when it should just be the first step on the road to recovery.

There are an estimated 265,000 heroin addicts in England, with 165,000 currently being treated. About 150,000 of these are prescribed a substitute medication, typically methadone or buprenorphine, as part of their treatment.

Paul Hayes, chief executive of the National Treatment Agency for Substance Misuse, said: ‘This report acknowledges that long-term international studies suggest currently only a minority of heroin addicts fully recover. Our ambition is for the English treatment system to become a world leader in delivering recovery outcomes, ensuring every individual in treatment is given the opportunity to leave addiction behind.'

Dr Linda Harris – medical director of the RCGP substance misuse unitand chief executive and clinical director of Spectrum Community Health, who formed part of the research group – said: ‘There has been a culture of commissioning that has been skewed more towards a medical model. GPs play a critical role in treating patients with substance misuse and there is a great opportunity for doctors to act to embrace recovery by taking a more patient-centred approach.'

The report said: ‘Most people who enter treatment want to recover and break free of their drug dependence. We can help more to realise this ambition if we can ally safe, evidence-based, recovery-oriented practice to the public health and wider social benefits we already accrue from treatment. There is no justification for poor-quality treatment anywhere in the system. It is not acceptable to leave people on opioid substitution therapy without actively supporting their recovery and regularly reviewing the benefits of their treatment – as well as checking, responding to and stimulating their readiness for change.'

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