SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Clinical & Policy Updates:
SMMGP Policy Update September 2007

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Adobe Acrobat DocumentDownload the PDF version of this Update here! (PDF*, 41K)


Drug Misuse & Dependence - UK Guidelines for Clinical Management (4th edition)

They're here! They have been effectively edited since their consultation draft and are now a more digestible 132 pages. Dr Nat Wright, one of the working group, summarises it thus...

"As an update it has taken account of developments in the field. Adequate dosing of opiate maintenance therapy is espoused and, as a progression from the 1999 guidelines, the prescribing of buprenorphine in primary care is endorsed. In fact the section dedicated to primary care takes account of and acknowledges the diversity of treatment models that are now operating in the field of primary care. An added section on prisons highlights the increasing need for treatment that is integrated right through the treatment system. Compared to the 1999 edition the extended and enhanced role of the nurse with additional skills management of substance dependence is acknowledged in particular non-medical prescribing. It is possible that some aspects of the guidelines will stimulate further debate, for example the place of contingency management in the drug treatment field is likely to be a story that evolves, as is the role of cardiac monitoring for those on high dose methadone maintenance therapy. However, whilst some may consider the update to be too long, the guidelines are certainly comprehensive in their coverage of the treatment journey. The topics of assessment, pharmacological, psychosocial and harm reduction interventions are covered and the need for equivalence of the quality of care in both traditional and criminal justice settings is highlighted".

SMMGP will be producing a special edition of Network in November concentrating on the content and implications of the new "Orange Book" as well as the suite of recently published NICE guidelines and Technology appraisals.


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NTA Recent Publications

Topically the NTA has published commissioner guidance on implementing psycho-social interventions by the International Treatment Effectiveness Project. It uses mapping to unpick the effectiveness of interventions in keyworker sessions. Rather strangely it makes no reference to the recent NICE psycho-social guideline. See

The NTA has also published a report on the harm reduction findings of the National User Survey which make interesting reading, concluding that "The survey clearly indicates the need to enhance harm reduction across of the whole of the treatment system and in all treatment tiers, with targeted interventions for those most at risk and those who have been less likely to be reached by harm reduction advice and interventions". See

Another recent NTA publication is a guide for users on getting help for a drug problem, which gives a clear description of what users can expect from treatment services. It would be a useful leaflet to have in waiting rooms. See

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Criminal Justice Policy

The impact of enforcement on street users in England
Sarah Johnsen and Suzanne Fitzpatrick
This thoughtful report from the Joseph Rowntree foundation looks at the effect of the whole rafter of criminal justice initiatives and legislation on the Street Homeless drug using population. Read it all on

Prisons and drugs: a global view of incarceration, drug use and drug services
Dolan, K (et al.)
Another thoughtful report. It makes the good point that governments who deny prisoners' access to the services that are available outside prison may face legal challenges for denying the human rights of prisoners. This brief review asserts that drug use poses serious problems for prisons and that prisons are an important setting for the provision of drug and HIV services. Read the whole report at

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Global Drugs Policy

If you are interested in global drug policy then this is an analytical report form the International Drug Policy Consortium, which dissects, questions and debunks the United Nations World Drug Report, which it claims, has distorted the truth and produced selective conclusions. Its main recommendation was "That the concept of 'zero tolerance' or a 'drug free world' be replaced by more realistic policy objectives focussing on the reduction of the harmful consequences of drug production and use". The full document is at

After the War on Drugs: Tools for the debate
Transform's latest publication is typically assertive and hard-hitting. This is their detailed guide to making the case for drug policy reform. As usual it will divide opinion but it is definitely readable and the full text can be downloaded at

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Safe Sensible Social- The Next Steps in the National Alcohol Strategy
We apologise that this one got left out of the last policy update, however this is a very significant publication for the alcohol field from the Department of Health. Enthusiasts say that this sends an upbeat and positive message to the population to drink sensibly and safely rather than adopting an off-putting negative tone. Critics say that it is too positive and doesn't emphasise alcohol related harm, doesn't mention dependent drinkers at all, is overly focussed on criminal justice issues and could have been written by the alcohol industry. Decide for yourself at