METHADONE MATTERS: EVOLVING COMMUNITY METHADONE TREATMENT OF OPIATE ADDICTION; ED. BY GILLIAN TOBER

Methadone Heals, But Methadone Kills. Methadone Is A Life-saving Treatment, But Methadone Is Also A Life-threatening Poison. The Challenge Is How To Confer The Benefit Witout Incurring The Harm. And This Is What This Book Is About. It Comprises Chapters From The Best Of Clinicians, Researchers, And Policymakers, And Is An Essential Guide To Increasing The Relevance And Effectiveness Of Methadone Treatment. Section A: Introduction, Background And Scope -- Methadone: Panacea Or Poison? / J. Strang And G. Tober -- The History Of Methadone And Methadone Prescribing / A. Preston And G. Bennett -- Methadone Prescribing In The United Kingdom: What Can We Learn From Community Pharmacy Surveys? / J. Sheridan -- Section B: Aspects Of Clinical Practice And Variations -- Negotiating A Script: The Dynamics Of Staff/client Relationships / A. Quirk ... [et Al.] -- Linking Psychology And Pharmacology / D. Raistrick -- Assessment And Outcome Monitoring / J. Marsden, M. Gossop And D. Stewart -- Plasma Methadone Monitoring: An Aid To Dose Assessment, Monitoring Compliance And Exploration Of Drug Interactions / K. Wolff -- Withdrawal From Methadone And Methadone For Withdrawal / N. Seivewright And O. Lagundoye -- Section C: The Special Case Of Injectables -- Injectable Methadone: A Peculiar British Practice / J. Strang And J. Sheridan --^ Prescribing Injectable Methadone: To Who And For What Purpose? / L. Sell -- The Supervised Injecting Clinic: A Drug Clinic's Experience Of Supervising The Intravenous Self-administration Of Prescribed Methadone / M. Cummins -- Section D: The Risks -- Dependence On Methadone: The Danger Lurking Behind The Prescription / G. Tober -- 'using On Top' And The Problems It Brings: Additional Drug Use By Methadone Treatment Patients / D. Best And G. Ridge -- Methadone And Opioid-related Deaths: Changing Prevalence Over Time / M. Farrell And W. Hall -- The Play, The Plot And The Players: The Illicit Market In Methadone / J. Fountain And J. Strang -- Section E: Service Delivery -- A Primary Care Based Specialist Service / S. Lawrence -- A Central Assessment Service With Widely Disseminated Delivery In Primary Care / F. Watson, L. Mays And J. Bury -- A Centrally Co-ordinated City Strategic Approach / R. Watson, J. Jay And L. Gruer --^ Supervised Consumption Of Methadone In A Community Pharmacy / K. Roberts -- Section F: Special Cases -- A Methadone Programme For Substance-misusing Pregnant Women / A. Walker And J. Walker -- Methadone Use In Young People / E. Gilvarry, J. Mccambridge And J. Witton -- Sectin G: Methadone Studies -- Methadone Treatment: Outcomes And Variation In Treatment Response With Ntors / D. Stewart, M. Gossop And J. Marsden -- Rapid Benefit, But What Thereafter?: The Rush And Trickle Of Benefit From Methadone Treatment / E. Finch -- Methadone Maintenance And Reduction Treatments: The Need For Clarity Of Goals And Procedures / M. Gossop, J. Marsden And D. Stewart -- Section H: In Conclusion -- Methadone: Achieving The Balance / G. Tober And J. Strang. Edited By Gillian Tober, John Strang. Includes Bibliographical References And Index. Section A: Introduction, background and scope......Page 17 1. Methadone: panacea or poison?......Page 18 2. The history of methadone and methadone prescribing......Page 28 3. Methadone prescribing in the united kingdom: what can we learn from community pharmacy surveys?......Page 36 Section B: Aspects of clinical practice and variations......Page 45 4. Negotiating a script: the dynamics of staff/client relationships......Page 46 5. Linking psychology and pharmacology......Page 57 6. Assessment and outcome monitoring......Page 66 7. Plasma methadone monitoring: an aid to dose assessment, monitoring compliance and exploration of drug interactions......Page 78 8. Withdrawal from methadone and methadone for withdrawal......Page 89 Section C: The special case of injectables......Page 98 9. Injectable methadone: a peculiar british practice......Page 99 10. Prescribing injectable methadone: to whom and for what purpose?......Page 114 11. The supervised injecting clinic – a drug clinic’s experience of supervising the intravenous selfadministration of prescribed methadone......Page 126 Section D: The risks......Page 136 12. Dependence on methadone: the danger lurking behind the prescription......Page 137 13. ‘Using on top’ and the problems it brings: additional drug use by methadone treatment patients......Page 147 14. Methadone and opioid-related deaths: changing prevalence over time......Page 161 15. The play, the plot and the players: the illicit market in methadone......Page 172 Section E: Service delivery......Page 182 16. A primary care based specialist service......Page 183 17. A central assessment service with widely disseminated delivery in primary care......Page 193 18. A centrally co-ordinated city strategic approach......Page 203 19. Supervised consumption of methadone in a community pharmacy......Page 214 Section F: Special cases......Page 225 20. A methadone programme for substance-misusing pregnant women......Page 226 21. Methadone use in young people......Page 236 Section G: Methadone studies......Page 247 22. Methadone treatment: outcomes and variation in treatment response within NTORS......Page 248 23. Rapid benefit, but what thereafter? the rush and trickle of benefit from methadone treatment......Page 258 24. Methadone maintenance and reduction treatments: the need for clarity of goals and procedures......Page 269 Section H: In conclusion......Page 281 25. Methadone: achieving the balance......Page 282 A......Page 289 C......Page 290 F......Page 291 I......Page 292 N......Page 293 P......Page 294 R......Page 295 S......Page 296 T......Page 297 Y......Page 298 Methadone heals, but methadone kills. Methadone is a life-saving treatment, but methadone is also a life-threatening poison. The challenge is how to confer the benefit without incurring the harm. And that is what this book is all about. Methadone is by far the most widely prescribed drug in the treatment of heroin addiction, and yet, all too often, we are clumsy in our use of this powerful drug. So how much of the observed benefit is to do with methadone itself? Does dose matter? How important is the psychosocial component of care? How can problems of poor compliance be addressed? Is supervised consumption feasible, and, if so, is it justifiable and beneficial? And what is injectable methadone all about? When is it ever prescribed, and for whom, and how? And what about the dangers? Methadone itself can be the actual drug of overdose. How successful have efforts been made to re-structure methadone treatment to prevent overdose deaths? and how can the problems of diversion to the illicit market be kept to a minimum? This multi-authored book, comprising chapters from the best of clinicians, researchers and policymakers, is the essential guide to increasing the relevance and effectiveness of methadone treatment. Like it or loathe it, Methadone Matters .