MRCPsych addiction psychiatry seminar series Policy, guidance and legal framework of addiction treatment Classification of substance use disorders Assessment Epidemiology of addictive disorder and their natural history Dr Stuart McLaren 2 nd March 2012

The policy approach Harm reduction versus abstinence Recovery movement

Recent NICE guidance Technology appraisals: –methadone, –buprenorphine –naltrexone Drug misuse clinical guidelines: –opioid detoxification (CG 52) –psychosocial interventions (CG 51) Alcohol-use disorders: –management of alcohol-related physical complications (CG 115) –diagnosis, assessment and management of harmful drinking and alcohol dependence (CG 100)

Department of Health guidelines 2007 Drug misuse and dependence: UK guidelines on clinical management ‘the orange book’

Misuse of Drugs Act 1971 and Regulations 2001 Class A – cocaine, ecstasy, heroin, LSD, methadone, Class B drugs injected Class B – amphetamines, barbiturates, codeine Class C – anabolic steroids, minor tranquillisers, cannabis

Regulations Schedule 1 – no therapeutic value (cannabis,LSD) Schedule 2 & 3 – can be prescribed (heroin, amphetamine, temazepam) Schedule 4 – can be prescribed (mostly benzodiazepines) Schedule 5 – over the counter medications

Implications Doctors can prescribe: Amphetamines Barbiturates Cocaine** Heroin** Methadone ** need HO license to prescribe to ‘addicts’

Mental Health Act 2007 No change! Exclusion of drug and alcohol dependency was retained F1x.4 withdrawal state with delirium F1x.5 psychotic disorder F1x.6 amnesic disorder F1x.7 residual and late-onset psychotic disorder