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Drugs of dependence - Full report

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Drugs of dependence: The role of medical professionals (PDF, 1.6mb)


Executive summary and chapters

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Executive summary

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Chapter 1 - Introduction

  • Substance use as a medical disorder
  • The legal framework for illicit drugs
  • Summary

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Chapter 2 - The scale of the problem: illicit drug use in the UK

  • Prevalence and patterns of use
  • Trends in illicit drug use
  • Young people and use of illicit drugs
  • Emerging trends
  • Attitudes to illicit drug use and policy in the UK
  • International perspectives
  • Summary

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Chapter 3 - The burden of illicit drug use

  • Introduction
  • Measuring the level of harm
  • Primary and secondary health harms
  • Social harms
  • The economic and social costs of illicit drug use
  • Summary

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Chapter 4 - Influences on illicit drug use

  • Introduction
  • Biological factors
  • Psychological factors
  • Social factors
  • Access to drugs.
  • Psychological attractiveness and societal acceptance
  • Summary

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Chapter 5 - Drug policy in the UK: from the 19th century to the present day

  • Introduction
  • The beginnings of drug control in Britain
  • Domestic policy developments and international drug control
  • The Rolleston Committee
  • Increasing international drug control
  • Growth of drug use in Britain and the 1960s heroin crisis
  • The UN Single Convention on Narcotic Drugs 1961 and the Misuse of Drugs Act 1971
  • Heroin use grows in the 1980s
  • The AIDS epidemic and treatment policy
  • Crime and a redesign of British drug policy
  • Summary

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Chapter 6 - Controlling illicit drug use

  • Introduction
  • Evaluating prohibition
  • The benefits of a prohibitionist approach
  • The costs of a prohibitionist approach
  • Debate on the need for reform
  • What are the options for an alternative legal framework?
  • Call to consider alternative options for drug policy
  • Conclusions
  • Summary

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Chapter 7 - Delaying initiation and minimising the use of illicit drugs

  • Introduction
  • Interventions for preventing drug use
  • Evaluation of prevention strategies: conclusions
  • Summary

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Chapter 8 - Medical management of drug dependence: the doctor's role in managing heroin addiction

  • Introduction
  • Managing drug dependence as a medical issue
  • Example of managing drug dependence as a medical issue: OST
  • What are the components of effective OST?
  • The limitations of treatment for heroin addiction
  • The safety of OST
  • Research, training and resources for effective delivery of OST
  • Summary

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Chapter 9 - Medical management of drug dependence: reducing secondary health harms

  • Provision of healthcare and identification of drug use as a health issue
  • Opportunistic brief intervention
  • Safe prescribing
  • Management of withdrawal
  • Relapse prevention
  • Illicit drug use in pregnancy
  • Summary

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Chapter 10 - Medical management of drug dependence in the context of criminal justice: illicit drug use, courts and prison

  • Introduction
  • Drug use prior to, during and after incarceration
  • Reducing the supply of drugs entering prisons
  • How effective are current treatment modalities?
  • Opioid detoxification in the prison setting
  • Reducing blood-borne virus transmission
  • 'Drug-free' wings
  • Reducing drug-related deaths in custody and after release
  • Seamless transfer to community services from prison release
  • Take-home naloxone
  • Promoting recovery after release from prison
  • Research, training and resource needs
  • Summary

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Chapter 11 - The role of healthcare professionals

  • Introduction
  • Current trends in the UK
  • Issues arising from these trends
  • Basic medical competence
  • Managing patients with drug-related health problems
  • Promoting public health policies and practices to reduce drug-related harm
  • Conclusion
  • Summary

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Appendix 1: Membership of the BMA Board of Science Reference Group
Appendix 1 (PDF, 71k)

Appendix 2: The nature and addictiveness of commonly used illicit drugs
Appendix 2 (PDF, 44k)

Appendix 3: Health-related harms of emerging and established licit and illicit drugs commonly used in the UK
Appendix 3 (PDF, 165k)

Appendix 4: UK illicit drug usage data
Appendix 4 (PDF, 31k)

Appendix 5: Overview of drug adulterants
Appendix 5 (PDF, 61k)

Appendix 6: UK government strategies for reducing illicit drug use
Appendix 6 (PDF, 39k)

Appendix 7: Societal measures to restrict drug influences
Appendix 7 (PDF, 410k)

References (PDF, 228k)



Please contact the BMA Board of Science department to purchase a hard copy of the report for £29.99

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BMA House
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