There are several ways in which doctors can help reduce the harm associated with illicit drug use.
1. Recognise when illicit drug use is contributing to health risks in a patient
All doctors in clinical practice will encounter patients adversely affected by illicit drug use. By acting in a non-judgemental way, they can support accurate diagnosis of drug-related harm, the provision of appropriate advice and referral for specialised support. The use of opportunistic brief interventions, for example providing information and advice when attending a needle and syringe sharing exchange or primary care setting, can support patients in stopping drug use, or using drugs in less harmful ways.
2. Support the treatment of illicit drug dependence
Some doctors, particularly GPs and psychiatrists, will often be responsible for supporting the treatment of drug dependency. This includes managing withdrawal and relapse prevention, as well as maintenance prescribing. As the following case study highlights, this can often involve a range of complex care needs.
Drug misuse and dependence: UK guidelines on clinical management (the ‘orange guidelines’) provide clinical guidance to support this. The guidelines were updated in July 2017 following a review by an expert working group. This reflected developments in the evidence for drug treatment, in the demands on services and in the treatment delivered, including:
- an ageing cohort of those with heroin dependence in treatment
- legislative changes to allow non-medical prescribers to assess, diagnose and independently prescribe for the treatment of drug dependence
- emerging risks from new psychoactive substances and changing patterns of drug use
- a more explicit focus on individually defined recovery journeys with an enhanced focus on pharmacological and psychosocial interventions, and peer engagement and mutual aid.
Case study: considering complex care needs not criminal records
London consultant addiction psychiatrist Emily Finch is treating up to 400 illicit drug users and alcohol-dependent patients in south London at any given time, including prisoners at HMP Brixton. Dr Finch leads the addictions clinical academic group at the South London and Maudsley NHS Foundation Trust and has spent 20 years helping substance users.
She says: ‘Our treatment services are dominated by complex drug users many of whom are homeless and have substantial psychical health problems. They are high users of healthcare. We also see a group of alcohol users who tend to be resistant to treatment and have dual diagnoses.
‘Many of our patients have hepatitis C and have injecting complications. Many are involved with the criminal justice system in a range of different ways.
‘As doctors, it is not our place to question the client’s criminal behaviour but to help them access healthcare and provide treatment which gets the best possible benefits for them.
‘Prison treatment is much better than it was. But patients in prison are not fully committed to recovery. You are using it as an opportunity but you can’t help them rehabilitate to work, you can’t improve wider aspects of their life such as relationships.
‘We know that methadone treatment [for opiate users] is effective and we know that methadone reduces deaths. Helping people recover and live drug-free lives is the objective but there is very little research on the sort of interventions that help achieve that.
‘In fact there is some concern in our treatment services that many recovery interventions are being provided without much evidence for their effectiveness.
‘We really do need to evaluate alternative interventions more effectively.’
This case study was taken from Drugs of dependence: the role of healthcare professionals.
3. Advocate for policies to minimise drug-related harm
All doctors, particularly those in public health and specialist drug services, can advocate for policies to minimise drug-related harm in their community. This can range from working with professional organisations – including the BMA and medical royal colleges – to lobby for health to be a central feature of drug policy; to encouraging the use of evidence-based harm reduction measures in their local area.
For the latter, the BMA supports the introduction of a wider range of evidence-based interventions for treating illicit drug dependence – such as heroin assisted treatment and supervised consumption rooms – in areas of high levels of need.
Download our briefing for further detail about these treatment approaches