There's been a notable lack of any discussion about the NTA's recent announcements on diamorphine prescribing for drug addiction. Is that because you've all been discussing it 'till you're blue in the face and I've missed it, or is there some darker hidden reason?!

http://smmgp.groupee.net/eve/f...081027792#1081027792

Hi Rich,
There are other links you can find using the search function. I can't imagine many of us will be prescribing Diamorphine though.

There is no doubt that this is interesting and potentially useful research, however......


When this study was launched there were media reports, I had several clients enquiring how they could become part of the study. There is no doubt that many would love to have heroin without the hassle of street buying (although there are some who enjoy this 'thrill' too.)

My concern is that this becomes an aspiration for some, who will work very hard to become complex and entrenched users s as to qualify for this treatment.

It's a bit like IVF, first developed for those who have difficulty conceiving, has become a way for perfectly fertile people to acquire the children they aspire to in terms of gender, intelligence, attractiveness etc.

I think there may be unintended consequences to this development too.

I have only read the media reports but they have been largely favourable because of the reported reduction in crime. The problem with this study is that it is patient reported crime and there was no attempt to obtain objective data from the police.
Perhaps a retrospective arrest rate score pre and post heroin prescribing startup would be the gold standard research

Jerry, you mean in a TOP form?

http://www.addictiontoday.org/...ch-not-research.html

This seems rather scathing on the pilot, not sure it's called for.

Given the apparent breach of academic protocol regarding peer-review, and the problems created by inadequate scrutiny of such as the Wakefield paper on MMR and autism research, one would think caution would be the order of the day.

But drugs is political, and wars have been declared on the basis of less well substantiated porfolios than this.

Surely it can't be true?

Can't offer an intelligent response at this time of evening, but did you see Mock the Week ? They managed to frame it as a no-brainer- i.e. who wouldn't want free heroin rather than a less euphoric substitute ?
Strict inclusion criteria needed. Strict supervision or monitoring of safe use / OD risk / disposal of sharps etc. Noticed on a google search that in Switzerland they allow some clients to take it out of the building.
But I haven't read the full details of the UK trial yet. Must be quite costly too, and as treatment funds decrease and possible a new government waits in the wings, will it take off ? Still doesn't mean it shouldn't be looked into.

Also agree about some people making a case for their inclusion just to get free heroin.
We have a young client who is making a case for methadone, built on her occasional use of heroin amongst other substances and a very odd looking drugs diary. She is going to extraordinary lengths to seek attention and even putting other ( non drug users ) at risk by asking them to inject her, when she says she usually smokes it
Out of interest, is injecting someone else actually against the law ? Clearly it could end up as a case of manslaughter if anyone does this to an opiate naive person.

I think it is a 'consenting adults' thing. If it goes wrong the onus would be on the injector to show that the injectee knew the risks and had consented, to reduce the sentence a court would hand down. Bit like the knife throwers assistant.

(warning, I am not a lawyer)

I wonder whether nurses working hours will change with patients being on supervised injections 7 days a week?

Nurses have offered a 24/7/365 service since time immemorial. It's the time and a quarter for Sunday that draws us in

http://www.cfenet.ubc.ca/video...?id=23&sid=33&cat=49
The presentation by Sarah Levine may be of interest - this is about the supervised injecting rooms in Vancouver. The other presentations are also of interest. If anyone can get to IHRA conference it is good.

Having got this far on the thread I finally realised that I hadn't actually read the NTA statement.
So for anyone as daft as me - here's the link
http://www.nta.nhs.uk/media/me...le_heroin_trial.aspx

Jeff

quote:

Originally posted by gill redshaw:
Out of interest, is injecting someone else actually against the law ?

Yes, and in two respects. It's a supply of a prescription only medicine without due authority (unless, of course, the "someone else" is scripted for it). But there have been a couple of recent cases touching on this.

In R V Kennedy (No. 2) [2008] 1 A.C. 269, Kennedy prepared a syringe of heroin and handed it to B, who immediately injected himself and returned the syringe to him. He then left the room. B died shortly after as a result of the injection and Kennedy was charged with supplying a class A drug and manslaughter. The House of Lords ruled that he couldn't be guilty of manslaughter because B had a free choice whether to inject it or not. If Kennedy had given the injection, that would have been an offence under section 23 of the Offences against the person Act 1861 (administering a drug or noxious substance to another); if death resulted from that criminal act, he could also be charged with manslaughter.

This was tested by a Scottish court earlier this year (MacAngus v HM Advocate, Kane v HM Advocate 2009 S.L.T. 137) when MacAngus was charged with causing death by supplying ketamine and Kane was charged with causing death by supplying and administering diamorphine. They claimed that the Kennedy decision above meant that they couldn't be charged with manslaughter (culpable homicide in Scotland). The upshot was that if they supplied it "recklessly" or administered it themselves, they could be charged with homicide. The legislation engaged is different in Scotland but the outcome would proably be the same in England.

Thanks for that
I thought I had read it somwhere, but not in such detail.
So if you have administered it, you could be charged with manslaughter.
And if you don't cause death, I imagine you could still be in a vulnerable position legally, especially if you are under age ( and so could the person asking to be injected ).
It's a childrens home that has this dilemma, and we are strongly urging them to find a safer place for the "drug user" ( to protect others ) whilst trying to quantify the drug use. We have offered low dose opiate Rx which was refused by client as does'nt want to be supervised. It is quite complex. Also trying to get advice on the psychology of this / psych help for our client.
It seems almost like Munchausen's by proxy, flaunting the fact that you call yourself a heroin user and going out of your way to involve others. Or PD ...... but they can't call this one " drug induced " as it has been going on long before illicit drugs were involved. Perhaps I should post a separate thread as we are veering off topic.

Yes, Gill. As is often the case, the Scots do this better. They have an offence of "culpable and reckless behaviour" which is a useful catch-all for a basket of things. For example, the butcher who sold meat with E coli 0157 in it was prosecuted under this, as was Stephen Kelly, who didn't tell his girlfriend he was HIV positive before having sex with her.

One relevance of C&RB to healthcare is that you can be guilty because you didn't bother to look into something, so it can cover omissions as well as commissions of error. So a guy who fired a rifle into a wood and didn't realise it could hit someone a mile off was guilty because he hadn't bothered to find out what its range was.

Gill,
it's also illegal if they know this person is using drugs on the premises and they don't take adequate steps to stop it. Some Nurses were imprisoned for this.

hi Gill,
This sounds like a very vulnerable person. Will need long, slow , patient help. I am sure you are right to ask for management advice of psychologists/psyychiatrists. I just hope, as you say, that they don't make the mistake of blaming everything on the drugs and underestimating the underlying problems, which clearly must be considerable.