DRUGS OF DEPENDENCE DEPENDENCE OF DRUGS THE ROLE OF MEDICAL PROFESSIONALS MEDICAL OF ROLE THE DRUGS OF DEPENDENCE THE ROLE OF MEDICAL PROFESSIONALS BMA Board of Science January 2013 BMA Board of Science Science of Board BMA £29.99 BMA Board of Science British Medical Association, BMA House Tavistock Square, London, WC1H 9JP www.bma.org.uk © British Medical Association, 2013 CODE: BMA 52888 / BOS BMA Board of Science DRUGS OF DEPENDENCE THE ROLE OF MEDICAL PROFESSIONALS January 2013 Drugs of dependence: the role of medical professionals i BMA Board of Science Editorial board A publication from the BMA Science and Education department and the Board of Science Chairman, Board of Science Professor Averil Mansfield Director of Professional Activities Professor Vivienne Nathanson Head of Science/Project Director Nicky Jayesinghe Editor Penny Howes Research and writing James Bell Owen Bowden-Jones Thomas Ellinas Kylie Reed Stephen Rolles George Roycroft John Witton Contributors Emily Finch Arsha Gosine Nicholas Green Elizabeth Rough Editorial Secretariat Grace Foyle Hugh Garnett Darshna Gohil Emily Kell Chris Wood British Library Cataloguing-in-Publication Data. A catalogue record for this book is available from the British Library. ISBN – 10: 1-905545-67-3 ISBN – 13: 978-1-905545-67-4 Cover photograph: iStockphoto Printed by the BMA publications unit © British Medical Association – 2013 all rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, or stored in any retrieval system of any nature without written permission, except for permitted fair dealing under the Copyright, Designs and Patents Act 1988, or in accordance with terms of a licence issued by the Copyright Licensing Agency in respect of photocopying and/or reprographic reproduction. Application for permission for other use of copyright materials including permission to reproduce extracts in another published works shall be made to the publishers. Full acknowledgement of author, publisher and source must be given. ii Drugs of dependence: the role of medical professionals BMA Board of Science Board of Science This report was prepared under the auspices of the Board of Science of the British Medical Association, whose membership for 2012-2013 was as follows: Baroness Professor Sheila Hollins President Dr Mark Porter Chair of Council Dr Kailash Chand Deputy Chair of Council Dr Steve Hajioff Chairman of the Representative Body Dr Andrew Dearden Treasurer Professor Averil Mansfield Chairman Dr Peter Dangerfield Dr Shreelata Datta Dr Lucy-Jane Davis Dr Louise Harding Dr Peter Maguire Mr Ram Moorthy Professor Michael Rees Dr Philip Steadman Dr Andrew Thomson Dr Beryl De Souza (deputy member) The Board would like to thank all past members of Board and ex-Chief Officers of the Association who have contributed to the development of this report, in particular: Dr Hamish Meldrum (Chair of Council, 2007-2012) Dr Kate Bullen (Deputy Chair of Council, 2007-2012) Dr Peter Bennie (Chairman of the Representative Body, 2007-2010) Dr Richard Jarvis (Co-Chair, Public Health Medicine Committee, 2009-2012). Approval for publication as a BMA policy report was recommended by the BMA Board of Professional Activities on 8 November 2012 and by UK BMA Council on 28 November 2012. The Board of Science, a standing committee of the BMA, provides an interface between the medical profession, the Government and the public. The Board produces numerous reports containing policies for national action by Government and other organisations, with specific recommendations and areas for action affecting the medical and allied professions. Drugs of dependence: the role of medical professionals iii BMA Board of Science Acknowledgements The association is grateful for the help provided by the BMA committees and outside experts and organisations. We would particularly like to thank: Professor Neil McKeganey Director of the Centre for Drug Misuse Research. In 1994 Professor McKeganey opened the centre at the University of Glasgow. It undertakes research in such diverse areas as the impact of parental drug use on children, recovery from dependent drug use, the impact of drug use on prostitution, the effectiveness of drug-treatment services and the nature of preteen drug use. In 2011, the centre moved from the University of Glasgow to operate as an independent research organisation. The centre is currently undertaking work on the effectiveness of Suboxone® (buprenorphine and naloxone), the impact of drug and alcohol problems on doctors and dentists, and the effectiveness of prison- based drug treatment. Professor McKeganey has written widely on the topic of drugs policy and has contributed to the United-Nations-based International Narcotics Control Board. He is the author of over 150 academic papers and his most recent book Controversies in drug policy and practice was published in 2011 by Palgrave Macmillan. Professor Robin Room School of Population Health, University of Melbourne, and Director of the Centre for Alcohol Policy Research at Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia. He is also a professor at and was the founding director of the Centre for Social Research on Alcohol and Drugs at Stockholm University. He had previously directed research at the Addiction Research Foundation of Ontario (1991-1998) and the Alcohol Research Group in Berkeley, California (1977-1991). Professor Room has studied the effects of alcohol, drug and gambling policies. He is a co-author of a number of books on alcohol and drug policy, including Young men and drugs (National Institute on Drug Abuse, 1975), Alcohol in developing societies (Finnish Foundation for Alcohol Studies, 2002), Drug policy and the public good (Beckley Foundation Press and Oxford University Press, 2010), Cannabis policy – moving beyond stalemate (Oxford University Press, 2010) and Alcohol – no ordinary commodity (Oxford University Press, 2e, 2010). His research interests include historical, cultural and social epidemiological studies of alcohol and other drugs, including comparative research across psychoactive substances. iv Drugs of dependence: the role of medical professionals BMA Board of Science Reference group A reference group was established to provide expert advice to the BMA Board of Science during the development of this report. The group comprised senior members of affected professions who have demonstrated experience and interest in relation to the issue of drug use. Please see Appendix 1 for membership of the group. Declaration of interest Declarations of interest for outside experts have been provided in Appendix 1. For further information about the editorial secretariat or Board members please contact the BMA Science and Education Department, which holds a record of all declarations of interest: [email protected] Drugs of dependence: the role of medical professionals v BMA Board of Science Abbreviations AA Alcoholics Anonymous ACMD Advisory Council on the Misuse of Drugs ACPO Association of Chief Police Officers ATOS Australian Treatment Outcome Study BBFC British Board of Film Classification BCS British Crime Survey 1,4-BD 1,4-butanediol BSA British Social Attitudes (survey) BZP 1-benzylpiperazine CA Cocaine Anonymous CARAT counselling, assessment, referral, advice and throughcare CBT cognitive-behavioural therapy CM contingency management CND Commission on Narcotic Drugs CNS central nervous system CPS Crown Prosecution Service DDC Dedicated Drug Court DfE Department for Education DfES Department for Education and Skills DH Department of Health DIP Drug Interventions Programme DMT N,N-dimethyltryptamine DORA Defence of the Realm Act (1916) DRR Drug Rehabilitation Requirement DSM Diagnostic and Statistical Manual of Mental Disorders DTTO Drug Treatment and Testing Order DZ dizygotic ECA Epidemiological Catchment Area (study) EMCDDA European Monitoring Centre for Drugs and Drug Addiction ESPAD European School Survey Project on Alcohol and other Drugs GABA gamma-amino butyric acid GBL gamma-butyrolactone GHB gamma-hydroxybutyrate GMC General Medical Council HBSC Health Behaviour in School-aged Children (study) HBV hepatitis B virus HCV hepatitis C virus vi Drugs of dependence: the role of medical professionals BMA Board of Science HRQoL health-related quality of life ICD International Classification of Diseases IDTS Integrated Drug Treatment System IEP injecting equipment provision IMD Index of Multiple Deprivation INCB International Narcotics Control Board IQ intelligence quotient LEEDS Leeds Evaluation of Efficacy of Detoxification Study LGBT lesbian, gay, bisexual and transgender LSD lysergic acid diethylamide MDA 3,4-methylenedioxyamphetamine MDEA 3,4-methylenedioxyethylamphetamine MDDB methylbenzodioxolylbutanamine MDMA 3,4-methylenedioxymethamphetamine (ecstasy) MMDA 3-methoxy-4,5-methylenedioxyamphetamine MSM methylsulfonylmethane 4-MTA 4-methylthioamphetamine MT methadone treatment MXE methoxetamine MZ monozygotic NA Narcotics Anonymous NGO non-governmental organisation NICE National Institute for Health and Clinical Excellence NOMS National Offender Management Service NTA National Treatment Agency NTORS National Treatment Outcome Research Study OST opioid substitution therapy OTC over-the-counter (drug) PCP phencyclidine PHE Public Health England PMA paramethoxyamphetamine PMMA paramethoxymethamphetamine PMSU Prime Minister’s Strategy Unit PSHE personal, social and health education QoL quality of life RCP Royal College of Physicians RCT randomised controlled