6.1.2 Arguments Regarding Various Prescribing and Treatments

Awareness of the Arguments for and Against the Various Types of Prescribing and Treatment Modalities

Awareness of the arguments for and against various types of prescribing and treatment modalities for substance misuse/addictions is important for healthcare providers, policymakers, and individuals with substance use disorders. One of the most contentious issues is the use of medication-assisted treatment (MAT) for opioid use disorders. MAT involves the use of medications such as methadone, buprenorphine, and naltrexone to help manage cravings and withdrawal symptoms and support recovery. Supporters argue that MAT is effective at reducing overdose deaths and improving treatment outcomes, while opponents argue that it simply substitutes one addiction for another and may not address the underlying issues contributing to the addiction.

Other types of prescribing and treatment modalities include abstinence-based programs, behavioural therapies, and harm-reduction strategies. Abstinence-based programs such as Alcoholics Anonymous and Narcotics Anonymous emphasize complete abstinence from all drugs and alcohol and may be effective for some individuals. However, others may require a more flexible approach that includes harm reduction strategies such as needle exchange programs and safe injection sites. Behavioural therapies such as cognitive-behavioural therapy (CBT) and contingency management have also been shown to be effective in treating substance use disorders.

Overall, the best approach to treating substance use disorders may depend on the individual’s specific needs and circumstances. It is important to consider a range of options and weigh the potential benefits and drawbacks of each treatment modality.

Legal Restrictions on Prescribing

In the UK, there are legal restrictions on prescribing for substance misuse and addiction. These restrictions are designed to prevent the diversion and abuse of controlled drugs and to ensure that prescribing is safe and appropriate.

Under the Misuse of Drugs Act 1971, there are three categories of controlled drugs, each with different prescribing requirements. Schedule 2 drugs, which include opioids such as morphine and fentanyl, can be prescribed for the treatment of addiction, but there are strict requirements for prescribing, storage, and record-keeping. Schedule 3 drugs, which include anabolic steroids and some benzodiazepines, can also be prescribed for addiction treatment, but with less stringent requirements. Schedule 4 drugs, which include most benzodiazepines, can only be prescribed for medical purposes and not for the treatment of addiction.

In addition to these legal restrictions, the General Medical Council (GMC) provides guidance to doctors on prescribing for substance misuse and addiction. This guidance emphasizes the importance of a comprehensive assessment, careful monitoring, and appropriate referral to specialist services.

References:

1. Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066. https://doi.org/10.1056/nejmp1402780
2. Harm Reduction International. (2019). The Global State of Harm Reduction 2019: An international guide to the harm reduction response. Harm Reduction International. https://www.hri.global/global-state-harm-reduction-2019
3. National Institute on Drug Abuse. (2020). Treatment approaches for drug addiction. https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
4. The Misuse of Drugs Regulations 2001. UK Statutory Instruments 2001 No. 3998. http://www.legislation.gov.uk/uksi/2001/3998/contents/made
5. General Medical Council. (2019). Good practice in prescribing and managing medicines and devices. https://www.gmc-uk.org/-/media/documents/prescribing-guidance-english-1015_pdf-51527435.pdf
6. National Institute for Health and Care Excellence. (2021). Drug misuse: opioid detoxification. Clinical guideline [CG52]. https://www.nice.org.uk/guidance/cg52