News December 2018 Newsletter Free webinar “How to deliver effective opioid substitution treatment in prison” If you’re quick you can still register for our free webinar on Monday 10th December. A panel of experts will present on the above topic. This webinar provides one hour CPD and certificates will be issued. Clinical Update Our Clinical Updates provide a summary of recent research papers, with expert commentary by Tom Jones, Senior Addiction Liaison Nurse, South London and Maudsley NHS Foundation Trust. Below is an item from the most recent update. (To access the full Clinical Update, please join as a Premium Member). Factors associated with methadone maintenance therapy discontinuation among people who inject drugs. Lo A., Kerr T., Hayashi K., Millroy M. J., Nosova E., Liu Y. & Fairbairn N. (2018) Journal of Substance Abuse Treatment, 94: 41-46. doi: 10.1016/j.jsat.2018.08.009. Click here to read. Why do patients discontinue methadone? This short paper examines some of the socio-demographic characteristics, substance use patterns and socio-structural exposures associated with methadone discontinuation among a cohort of people who use drugs (PWUD) in Vancouver, Canada. Data of 1301 PWUD across ten years was analysed. 22.1% of PWUD discontinued methadone at least once during the study period, though this number is lower than has been observed in other settings, where six-month retention rates typically range from 45-66%. The authors found that recent homelessness and incarceration, daily prescription opioid use, daily heroin injecting, and not accessing social income assistance were associated with methadone discontinuation. Commentary: The number of adults in England treated for opioid use disorders fell by 4% between 2016/17 and 2017/18, and a 14% reduction in numbers treated by substance misuse services (for all substance use disorders) has been observed over the last decade. Understanding some of the reasons that lead PWUD to leave treatment may help us to think creatively and better tailor our services to meet the needs of service users. Fundamentally we must understand that priorities shift for our patients, even if only temporarily. There may be an assumption on behalf of treatment providers that collection of a dose of methadone, or a new prescription, is the most important thing to PWUD all of the time. But we know that priorities change and the collection of a dose of methadone may be superseded by more pressing matters, such as access to food or shelter. The authors propose that access to housing and outreach services within substance misuse services may therefore support retention. The authors hypothesise that the ‘low threshold’ service provision model used in their study setting, where efforts are made to minimise barriers to service access, may contribute to the lower discontinuation rates observed in their study. Safe, easy to navigate pathways for accessing treatment, and methods for assertively re-engaging PWUD in treatment may go some way to improving retention rates; though one must not be naïve about the challenges of delivering services using these models of care within an underfunded system. Dose optimisation is another crucial approach to retaining patients in treatment. The authors found negative associations between methadone discontinuation and being on higher doses (>60mg). Regular review of doses is important and patients should be empowered to make informed decisions about dose increases and reductions. It is concerning, though not surprising, that daily prescription opioid use is associated with methadone discontinuation. Continuity of care is vital during transfers between custodial and other care settings. Acute hospitals need clear protocols for weaning off prescribed opioid analgesia, with collaborative plans that are shared with community prescribers. A major limitation of this study is that the exact temporal relationship between methadone discontinuation and the independent variables was not ascertained, so a causal link was not established. The data was also not studied qualitatively, which is a shame. Hearing from PWUD qualitatively may highlight some as yet undiscovered reasons for methadone discontinuation, which would allow us to adapt our services and improve treatment retention. News New SMMGP-FDAP website coming soon We will be launching our brand new website next month that will combine the existing separate SMMGP and FDAP websites. We can’t wait! The new format will make access and membership functions much easier. Watch this space. SMMGP Premium Membership Join our Premium Membership programme and benefit from quality CPD, gained by watching a webinar conveniently at your desk, or reading our full Clinical Updates. A certificate is issued to members each year listing the CPD programme totalling 15 hours. Webinars for Premium Members Experts in the field of alcohol and drug treatment discuss relevant topics in live online presentations for our Premium Membership scheme. Each webinar provides 1 hour CPD. Coming up: January 2019 – Premium Member CPD webinars When sex goes off the rails (Part 1) 16.01.19 at 10 a.m. Titrating OST in Prisons 21.01.19 at 7 p.m. SMMGP Premium Members have access to our full library of previous webinars covering a range of topics in the field. What’s on? 6TH Health and Justice Summit: Safety through continuity | 31.01.19 - 01.02.19 | LIVERPOOL A 2 day summit jointly organised by the RCGP Secure Environments Group, Broadmoor, Ashworth and Rampton high secure hospitals, Spectrum, Care UK, NHS England, Martindale Pharma, Nottinghamshire Healthcare NHS Foundation Trust, Betsi Cadwaladr University Health Board, HMP Berwyn, West London Mental Health Trust, Mersey Care NHS Trust. More information.