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<p>The prescribing of injectable opioids, such as methadone or diamorphine (pharmaceutical
heroin) as substitutes for illicit heroin, as outlined in the Government’s Modern
Crime Prevention Strategy, published in March by the then Home Secretary, has been
an option for many years but since the late 1960s, prescribing of diamorphine for
the management of addiction has been restricted to licensed addiction specialists.</p><p>The
decision to prescribe injectable diamorphine for the treatment of dependence is a
clinical matter, for a clinician to take in conjunction with the patient. Advice to
guide these decisions is contained in Chapter 5 and Annex 8 of the 2007 UK Guidelines
on the Clinical Management of Drug Misuse and Dependence. The guidelines advise that:</p><p>-
“injectable opioid treatment may be suitable for a small minority of patients who
have failed in optimised oral treatment.”;</p><p>- “clinicians providing injectable
opioid treatment should encourage patients not to regard it as a lifelong treatment
option and should regularly review their patients and the continuing necessity for
this unusual and expensive treatment”; and</p><p>- The use of diamorphine “alone does
not constitute drug treatment…it should be seen as on element or pathway within wider
packages of planned and integrated drug treatment”.</p><p>The guidelines are currently
being reviewed by an Expert Working Group, to take into account developments in the
evidence base. In July 2016, the Expert Working Group published their draft update
for consultation. The consultation has closed and the responses are being considered
by the Expert Working Group.</p><p>Diamorphine is licensed as a medicine by the Medicines
and Healthcare products Regulatory Agency. Clinicians wishing to legally prescribe
it for the treatment of dependence need to obtain a licence for that purpose from
the Home Office and to comply with all other legislation relevant to the safe management,
use and supply of medicines which are controlled drugs.</p>
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