The problem of drug abuse results in numerous problems including physical, psychological and social. Thus numerous treatment modalities are available to people with drug problems. These include pharmacotherapy, psychological help and social support (Leshner, 1999). Many times different modalities of treatment are combined with one another. Since the needs and treatment goals (maintenance or abstinence) of each individual are different, the treatment for drug abuse needs to be highly individualized (Leshner, 1999).
The treatments for drug abuse can be delivered in a variety of settings on outpatient (NHS drug dependency clinic; private clinic; general practice) or inpatient basis (e. g. Hospital detoxification unit or residential rehabilitation centre). Pharmacotherapy The U. K government through its “Drug Strategy” has provision for two main types of medical treatment of substance abuse disorders namely, heroin prescription and methadone therapy (Home Office, 2007). Heroin dependence is a chronic relapsing condition, and is often associated with development of relapse after treatment (Leshner, 1999).
This can have a significant impact over the social well-being and quality of life of these individuals. Substitute treatment, i. e. prescribing a substitute drug like methadone or pharmaceutical heroin (as a replacement for illicit heroin) may help in improving the quality of life of an individual by helping him attain remission and prevent relapse (Leshner, 1999). Though the evidence shows that oral methadone is the preferred treatment option in most cases where the individual has problems with opiate drugs, a minority of opiate users prefer to use heroin instead (Stimson & Metrebian, 2003). Methadone maintenance therapy
Methadone is a long-acting synthetic opiate drug, which produces same actions on the brain as that of opiate drugs which are derived naturally from opium. Methadone therapy is usually prescribed for those individuals who abuse either illicit opioid drugs (like heroin), or prescription opioids like codeine (Leshner, 1999). In UK, methadone is mainly prescribed for oral use, though it can also be prescribed through intravenous route (Stimson & Metrebian, 2003). Oral route has an advantage that it prevents the health risks due to transmission of HIV, hepatitis B etc, related to intravenous use of illicit use of drugs.
Substitution treatment with methadone helps in delaying or eliminating heroin withdrawal symptoms. This would thus help in reducing the amount of physical discomfort which would be suffered by a dependent person on stopping the drug and help him achieve abstinence. Another advantage of prescribing substitute drugs is that it would help in reducing the criminal activities, especially those associated with acquisition of drugs (Keen et al, 2000). Thus use of substitution treatment is an important strategy employed by the UK government to reduce the rates of drug related crimes (Home Office, 2007).
Evidence has also shown that methadone therapy helps in improving social functioning and overall quality of life in the drug addicts undergoing this therapy. Though there are other drugs like (buprenorphine), which can be used in place of methadone for substitute therapy, methadone is the most commonly prescribed substitute therapy in the U. K (Stimson & Metrebian, 2003). Heroin Prescription The Government, under the “updated Drug Strategy” aims to provide heroin prescription to those individuals who have “a clinical need for it” (Home office, 2007).
In this sense U. K is different from other countries in the world, since the UK government visualizes the strategy of prescribing heroin as important step for solving the problem of heroin addiction, whereas other countries feel that legalization of heroin prescription would further increase the problem of heroin abuse in the society (Stimson & Metrebian, 2003). Prescription of a known quantity and strength of heroin may be helpful in reducing the illicit use of the drug and help in reducing the black market for illicit heroin.
Stimson & Metrebian, 2003 have described the following situations under which the medical prescription of heroin is considered to be a legitimate clinical option in the UK. • Gradual reduction method of treatment is used in which the illicit drug is gradually substituted with heroin initially, which is later followed by intravenous methadone and then oral methadone in the end. • Individuals in whom it is not possible to completely withdraw the illicit drug due to emergence of severe withdrawal symptoms, which may require hospitalization for treatment.
• Cases where an individual is able to live almost normally if he takes the prescribed amount of drug illicit. The legalization of heroin prescription is a very controversial topic and different people have different views regarding this. People favoring the prescription of heroin give the following advantages: Prescription of heroin would be helpful in decreasing the rates of drug- related crime in the society, since the individuals would be easily able to acquire this drug without indulging in criminal activities.
Prescription of heroin would also help in reducing several health problems like over dosage and infectious disease like HIV, hepatitis B etc (Stimson & Metrebian, 2003). On the other hand, people against the provision of legalized heroin highlight many disadvantages, some of them include: It has been thought prescription of heroin would result in an increase in the number of heroin users in the society and further encourage the development of dependence.
Prescription of heroin may cause the individual to continue injecting heroin resulting in adverse health consequences like risk of blood borne infections, abscesses etc and risks related to drug overdose (Stimson & Metrebian, 2003). In the U. K heroin can be prescribed by the specialists working in Drug Dependency Unit, Who have obtained a license for such prescribing from the Home Office. The drug is usually dispensed by a community or hospital pharmacy and is injected by an individual at home in an unsupervised manner. Heroin should be prescribed only in situations where rigorous monitoring and supervision is possible.
Though heroin prescription has been legalized in the UK, very little clinical indication for prescribed heroin has been found and it is prescribed to only a small group of individuals (Stimson & Metrebian, 2003). General practitioners in the U. K have been opposing the government decision of medically prescribing heroin, fearing that this would result in life-long addiction. On the other hand the U. K police department has been strongly supporting this government decision as this policy has been greatly helpful in reducing the rates of crime in the UK. (B.
B. C, 2000). Model of care for Provision of drug treatment services in the UK The home office (2007), through its “upgraded Drug Strategy” has described a model of care showing how the treatment for drug problems is carried out at various levels by different treatment providers in the UK. The Home office (2007) has described a tiered system of treatment comprising of four different tires, namely the general services (tire 1), open access services (tire 2), community services (tire 3), specialist services (tire 4a) and highly specialized care (tire 4b).