The recommendations relate to people over the age of 18 who inject illicit substances and non-prescribed anabolic steroids.
The guidance complements and supports, but does not replace, NICE guidance on drug and substance misuse (see related NICE guidance on the back page for a list of publications).
Downloads: Full report (PDF 287KB)
Quick reference guide: http://www.nice.org.uk/nicemedia/pdf/PH18QuickRefGuide.pdf (PDF)
Substance Misuse Management in General Practice (SMMGP) No One Written Off: Reforming Welfare to Reward Responsibility 2008. SMMGP Policy update
SMMGP, 2008.
This update outlines the SMMGP response to the No One Written Off paper.
Download: Full update (PDF 126KB)
Guidance on standards for the establishment and operation of drug consumption rooms in the UK.
Hunt N., JRF, 2008.
This report provides essential guidance for local multi-agency partnerships that are contemplating establishing and operating a drug consumption room (DCR) in the UK. A number of local partnerships across England, Wales and Scotland are currently discussing whether or how DCRs might help address their local drug problems. At present there are no DCRs in the UK, however, evidence elsewhere suggests that they can be valuable for engaging marginalised drug users, reducing overdose deaths and can have a beneficial impact on community safety in areas where public drug use is widespread.
This guidance:
- helps meet a need to define minimum operational standards, identified within the original Report of the Independent Working Group on Drug Consumption Rooms (JRF 2006);
- addresses international and domestic legal issues, including duty of care;
- examines the commissioning process, operational policies and procedures and monitoring and evaluation.
Download: Full report (PDF 180KB)
Reducing drug users’ risk of overdose
Rome A., Shaw A., Boyle K. Scottish Government, 2008.
This is the report of a research project looking at ways of reducing drug users’ risk of overdose, conducted by Figure 8 Consultancy and Scottish Drugs Forum, on behalf of the Scottish Government.The overall aim of the research was to recommend a range of interventions to reduce the number of drug-related deaths in Scotland. The research had two key objectives: To investigate how to increase the number of witnesses to drug overdose calling for help quickly; and to investigate what measures could be effective in preventing death from overdose while help is on its way.
Download: Full report (PDF 900KB)
Good practice in harm reduction
NTA, 2008.
The NTA publication, Good Practice in Harm Reduction (October 2008) helps service providers and commissioners improve harm reduction services for drug users. The guide is the result of interviews with a number of partnership areas who scored highly on the recent Healthcare Commission/NTA joint improvement review of harm reduction services. It seeks to identify what works well on the front-line and therefore what drug partnerships could do to improve their harm reduction services. It highlights how the top ten per cent best performing partnerships approach the planning and delivery of services which enabled them to score well in the improvement review. Not all these approaches will be relevant for every area, but the guide does contain a number of useful case studies which show how gaps in service provision in a range of urban and rural areas have been addressed.
Download: full report (PDF 387KB)
Supporting and involving carers: a guide for commissioners and providers
NTA, 2008.
This guide has been published to support the improvement in availability and quality of services for families and carers, as well as improving the involvement of families and carers in drug users’ treatment. The guide provides information for substance misuse commissioners and providers on the evidence base and good practice in commissioning and providing services for families and carers, as well as for involving them in drug users’ treatment. In addition to the main guidance, Appendix 1 (NTA, 2008) gives details of the evidence base for family and carer services and Appendix 2 (NTA, 2008) provides further information for specific groups.
Download: Full report (PDF 844KB) Improving the quality and provision of Tier 4 interventions as part of client treatment journeys: A best practice guide
NTA, 2008.
This guidance summarises key challenges that currently face the Tier 4 sector. It links the roles that each stakeholder group can play in jointly finding solutions and improvements. This document can be read in tandem with Models of Residential Rehabilitation for Drug and Alcohol Misusers (NTA, 2006), Drug Misuse and Dependence: UK Guidelines on Clinical Management, and Commissioning Tier 4 Drug Treatment (NTA, 2006). Reference should also be made to the World Class Commissioning Programme launched by the Department of Health in December 2007 (Department of Health, 2007). World Class Commissioning will deliver a more strategic and long term approach to commissioning services with a clear focus on delivering improved health outcomes. Many of the principles highlighted in this NTA best practice guidance, notably thorough needs assessments, partnership working and user involvement are reflected in the World Class Commissioning vision.
Download: Full report (PDF 395KB)
Identifying the role of families within treatment
Adfam/Madill Parker Research and Consulting, 2008.
This study has confirmed that families can be a useful resource in treating an individual's substance misuse problem. Among the recommendations are, better information on the impact of substance misuse on families to professionals and the general public and more evaluation to measure successful outcomes of family interventions.
Web: http://www.adfam.org.uk/docets/Identifying%20the%20role%20of%20families%20within%20treatment.pdf (PDF)
Safety, risks and outcomes from the use of injecting paraphernalia
Scott J., Scottish Government Social Research, 2008.
The final report of the findings of a study into the impact of providing paraphernalia to injecting drug users. Includes recommendations for good practice.
Web: http://www.scotland.gov.uk/Publications/2008/03/14133736/11 (PDF 740KB)
Principles of drug dependence treatment
WHO, UNODC, 2008.
This discussion paper aims to encourage Governments and other partners to take concerted action for the implementation of evidence-based drug dependence treatment services, which respond to the needs of their populations. Given the scale of the problem in most societies and the limited resources available, a clear and coherent approach to service planning is required. There is a need to develop services that can reach the maximum number of individuals and have the greatest impact at lowest cost. This is most likely to be achieved with broad community-based health care services that can work with individuals in their own communities over longer periods of time. While the present document recommends actions to promote each of the nine principles, these will need to be prioritized to respond to the local situation and circumstances and implemented in progressive steps in accordance with resource availability and stages of development of the treatment system.
Download: Full report (PDF 176KB)
Essential care: A report on the approach required to maximise opportunity for recovery from problem substance use in Scotland
Scottish Advisory Council on the Misuse of Drugs, 2008.
The majority of the Essential Care report is concerned with support that is needed to address problems in areas of drug service users’ lives other than addiction, such as general health, mental health and social skills and relationships. It lists all the areas which may need attention, together with evidence of their benefits. However the main conclusion is that there needs to be a major change in the philosophy of care for problem substance use in Scotland – focused on the recovery of each individual.
Download: Full report (PDF 300KB)
Guidelines for the evaluation of treatment in the field of problem drug use
EMCDDA, 2007.
The main objective of the guidelines is to provide a European audience with basic information on the options, elements and procedures of drug-related treatment evaluation. The target readership includes professionals working in treatment services for substance use and dependence, administrators and officials in social and health authorities, researchers dealing with treatment of substance dependence, and those who professionally or politically may have an interest in evidence from treatment evaluation.
Download: Full report (PDF 544KB)
Domestic violence, drugs and alcohol: good practice guidelines
Stella Project, 2007.
The information in this toolkit aims to provide practitioners and service managers within the domestic violence and substance misuse sectors with the basic knowledge and skills they require to respond to service users safely and appropriately. It has been compiled in consultation with practitioners from both sectors and provides practical guidance, case studies and sample documents enabling workers to use the toolkit as a reference and workbook.
Web: http://www.gldvp.org.uk/C2B/document_tree/ViewADocument.asp?ID=77&CatID=154
Non-medical prescribing, patient group directions and minor ailment schemes in the treatment of drug misusers
National Treatment Agency for Substance Misuse, 2007.
Non-medical prescribing (particularly nurse and pharmacist prescribing), patient group directions (PGDs) and minor ailment schemes (MAS) are all part of a range of NHS reforms designed to improve patients’ access to medicines, develop workforce capability, utilise skills more effectively and ensure provision of more accessible and effective patient care. Successful implementation requires robust clinical governance mechanisms and teamworking, as well as access to specialist pharmaceutical support. Commissioners, managers and practitioners can now explore the potential of all these different mechanisms as ways of improving access to medicines for drug misusers.
Download: Full report (PDF 253KB)
Audit of drug treatment prescribing services
National Treatment Agency for Substance Misuse, 2007.
The National Treatment Agency for Substance Misuse's guidelines on ethical prescribing for UK drug treatment providers. This document also contains information on new monitoring procedures to ensure the guidelines are followed by all doctors.
Web: http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/
docs/statement_on_medication_choice_and_dosing_in_drug_misuse
_and_treatment_14_12_07.pdf (PDF)
The International Treatment Effectiveness Project - Implementing psychosocial interventions for adult drug misusers
National Treatment Agency for Substance Misuse, 2007.
The International Treatment Effectiveness Project (ITEP) is part of the National Treatment Agency’s Treatment Effectiveness strategy, which identified areas for enhancing the quality of treatment interventions. The project was a collaboration between the NTA, the Institute of Behavioural Research (IBR) in Texas and severalservice providers in the north-west England and London. ITEP utilised a care planning approach (referred to as “mapping”) in the form of a manual, which was used by trained keyworkers with their clients. Previous research had shown that these psychosocial interventions had a number of positive outcomes in terms of clients’ treatment experiences and reductions in illicit drug use.
Download: Full report (PDF 421KB)
Drug Misuse and Dependence - UK Guidelines for Clinical Management
National Treatment Agency for Substance Misuse, 2007.
This is a new version of the 1999 Clinical Guidelines, commonly called the ‘Orange Book’. The new Clinical Guidelines build on the previous evidence-based and well-established Clinical Guidelines but reflect some of the considerable changes that have occurred in drug treatment over the past eight years. The latest Clinical Guidelines also reflects the recent suite of guidance from the National Institute for Health and Clinical Excellence (NICE).
Download: http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/
docs/nta_clinical_guidelines_2007.pdf (PDF 426KB)
Drug misuse: psychosocial interventions
NICE, 2007.
NICE has produced two guidelines on drug misuse – ‘Drug misuse: psychosocial interventions’ (NICE clinical guideline 51) and ‘Drug misuse: opioid detoxification’ (NICE clinical guideline 52). They cover: - the support and treatment people can expect to be offered if they have a problem with or are dependent on opioids, stimulants or cannabis
- how families and carers may be able to support a person with a drug problem and get help for themselves.
NICE clinical guideline 51 makes recommendations for the use of psychosocial interventions in the treatment of people who misuse opioids, stimulants and cannabis in the healthcare and criminal justice systems.
Web: http://www.nice.org.uk/CG51
Needs assessment guidance for adult drug treatment
NTA, 2007.
Describes the aims and objectives behind needs assessments and the processes involved in conducting one. Includes practical information on conducting research into prevalence, current provision, evaluation, commissioning and monitoring.
Download: Full report (PDF 1.53MB)
Treating drug misuse problems: evidence of effectiveness
Gossop M., National Addiction Centre, 2006.
This report reviews evidence of the effectiveness of a wide range of drug treatments, including; pharmacotherapies, psychological treatments, twelve step programs, brief interventions, needle exchange schemes and combined treatments.
Download: http://www.nta.nhs.uk/publications/documents/
nta_treat_drug_misuse_evidence_effectiveness_2006_rb5.pdf (PDF 811KB)
Best practice guidance for commissioners and providers of pharmaceutical services for drug users
Walker M., NTA, RPS, 2006.
The aim of this report is to provide commissioners and providers of pharmaceutical services for drug users with information and advice in order to inform commissioning and ensure best practice.
Download: http://www.nta.nhs.uk/publications/documents/
nta_best_practice_pharma_services_for_drug_users_pharmguide06.pdf
(PDF 414KB)
Supporting and involving carers
NHS, 2006
Guidance on how to commission consistent, effective and quality services for carers and family members affected by someone else's drug use.
Download: http://www.nta.nhs.uk/publications/
documents/nta_supporting_and_involving_carers_sept2006.pdf
Basic principles for treatment and psychosocial support of drug dependent people living with HIV/AIDS
WHO, 2006.
Over the past two decades, HIV infection has been added to the serious risks of injection drug use, and the diffusion of HIV associated with drug injecting not only creates medical and social problems for the millions of injecting drug users worldwide but for society at large. Yet many drug dependent people living with HIV/AIDS do not enjoy equitable access to HIV/AIDS treatment, care and support services for HIV/AIDS as a result of stigma and discrimination, of their own reluctance to seek treatment, and of the unavailability of HIV/AIDS treatment in programmes for injecting drug users. This guidance document, built on expert advice and developed in consultation with UNAIDS, articulates the central principles for treatment and support of HIV-positive injecting drug users.
Download: http://www.who.int/substance_abuse/publications/
basic_principles_drug_hiv.pdf (PDF 1.1MB)
Responses to drug misuse: treatment
RSA Drugs commission, RSA, 2006.
This paper looks at treatment as a response to drug misuse.
Download: Full report (PDF 707KB)
Models of residential rehabilitation for drug and alcohol misusers
NTA, 2006.
A review of types of residential treatment currently on offer, clinical standards, and guidance on best practice.
Download: Full report (PDF 699KB)
Needs assessment manual
NTA, 2006.
This manual aims to further develop the needs assessment methodology issued in 2005 and provide guidance for local partnerships and NTA regional teams.
Download: http://www.nta.nhs.uk/publications/documents/
nta_needs_assessment_manual_july_06.pdf (PDF 345KB)
Models of care: Update 2006
NTA, 2006.
This update is intended to build on the framework and concepts in Models of Care 2002 rather than replace them. It requires drug treatment commissioners and providers to have implemented the key tenets previously described in Models of Care 2002.
Download: http://www.nta.nhs.uk/publications/documents/
nta_modelsofcare_update_2006_moc3.pdf
Drug intervention programme and prolific and other priority offenders programme: emerging practice and lessons
UK Home Office Drug Strategy Directorate, 2006.
This paper provides examples of emerging practice and lessons learned in relation to the working partnerships between CJITs and PPO teams in effectively case managing drug misusing PPOs.
Download: Full report (PDF 316KB)
Drug consumption rooms: summary report of the Independent Working group
Joseph Rowntree Foundation. Independent Working Group on Drug Consumption Rooms, JRF, 2006.
The IWG considers DCRs to be a rational and overdue extension to the harm reduction policy that has produced substantial individual and public benefits in the UK. They offer a unique and promising way to work with the most problematic users, in order to reduce the risk of ssen the damage and costs to society. overdose, improve their health and lessen the damage and costs to society.
Download: Full report (PDF 180KB)
Diversity manual
UK. Home Office, 2006.
The Diversity Manual is intended for use by regional government, local partnerships and delivery partners across the areas of crime and drugs. The Manual sets out the legislative framework requiring partnerships and service providers to commission and provide services appropriate to local needs. It identifies responsibilities relating to diversity, provides case studies of good practice and contains useful information and links and resources to support the delivery of services for local populations which are compliant with legislation.
Download: Full report (PDF 494KB)
Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers
NTA, 2005.
All organisations employing doctors need a robust clinical governance structure that addresses issues of education and supervision. This report recommends that appraisal must be carried out by a trained appraiser with experience of the clinical area. Supervision could be carried across different employing and specialty areas, so for example a consultant addiction psychiatrist could supervise a GP with special clinical interest working in their geographical area.
Web: http://www.nta.nhs.uk/publications/
documents/nta_doctors_roles_and_responsibilities_sept_2005.pdf
NTA/Home Office guidance for commissioning drug treatment Services from voluntary and community sector Organisations
NTA, 2005.
This guidance aims to provide the framework for a positive relationship between the purchaser and the service provider. A positive relationship will enable the maximum possible resources to reach the frontline, resulting in the best quality of service to be delivered.
Download: http://www.nta.nhs.uk/publications/
documents/nta_vs__compact_guidance.pdf (PDF)
Substance misuse in pregnancy: a resource book for professionals
DrugScope, 2005.
Based on an original publication from the Lothian Health Board, this book aims to establish a framework for care so that all women who use drugs can be offered appropriate support before, during and after the birth of their child. It discusses and provides information and intervention strategies on issues such as pre-conception care, the management of substance use in pregnancy, substitute prescribing, breastfeeding and neonatal Abstinence Syndrome (NAS).
Web: Please see the HIT website to purchase
Needle exchange for young people under 18 years old: a framework for providing needle exchange to young people
DrugScope, 2005.
Providing needle exchange services to young drug misusers is complex. Injecting is a dangerous activity, every effort should be made to encourage all young injectors to change their route of administration to a safer one, engage into treatment as urgently as possible and stop using drugs. The principle of reducing harm must not be lost when considering young drug misusers. However, additional harmful factors and the difference in legal status must be carefully considered and balanced.
Download: Briefing (PDF 71KB)
Nurse prescribing in substance misuse
UK. National Health Service. National Treatment Agency for Substance Misuse, NTA , 2005.
This briefing aims to clarify the current situation in relation to nurse prescribing in the substance misuse sector. It provides information to commissioners, treatment providers and health professionals on the potential role of nurse prescribing in service development. It will form part of a series of briefings, designed to provide updates on changes in regulations/legislation in relation to nurse prescribing and inform colleagues of the work of the National Treatment Agency (NTA), in supporting the development of clinical practice in this area.
Download: http://www.nta.nhs.uk/publications/documents/
nta_nurse_prescribing_in_substance_misuse_may_2005.pdf (PDF 286KB)
Prevention and treatment of substance misuse: delivering the right medicine: a strategy for pharmaceutical care in Scotland
Scottish Executive. National Pharmaceutical Forum, UK. Scotland. Scottish Executive. Scottish Medical and Scientific Advisory Committee, 2005.
This report sets out the present and future role of pharmacy in the provision of services to substance misusers. Two of the main recommendations relate to the inclusion of senior pharmacy representation on Drug and Alcohol Action Teams and access to specialist pharmacist advice on all areas of substance misuse.
Web: http://www.scotland.gov.uk/Publications/2005/08/2590211/02124
Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers
Royal College of General Practitioners, Royal College of Psychiatrists, 2005.
All organisations employing doctors need a robust clinical governance structure that addresses issues of education and supervision. This report recommends that appraisal must be carried out by a trained appraiser with experience of the clinical area. Supervision could be carried across different employing and specialty areas, so for example a consultant addiction psychiatrist could supervise a GP with special clinical interest working in their geographical area.
Download: http://www.nta.nhs.uk/publications/documents/
nta_doctors_roles_and_responsibilities_sept_2005.pdf (PDF)
Protocols and good practice guidelines for working with crack users in generic substance misuse services
Turning Point, 2005.
These protocols set out some underlying principles governing crack treatment provision and management support. They are intended as a tool to help guide the work of each service by clarifying its responsibilities.
Download: http://www.turning-point.co.uk/NR/rdonlyres/1255C03E-BD64-41CD-A68C-FB3F67352069/0/TP_CrackProtocols250705.pdf (PDF)
Guidance for the use of methadone for the treatment of opioid dependence in primary care
Ford C., Barnard J., Bury J., Carnwath T., Gerada C., Joyce A., Keen J., Lowe C., Nelles B., Roberts K., Sander-Hess C., Schofield P., Scott J., Watson R., Wolff K., SMMGP, 2005.
This document sets out guidelines for GPs in the care of patients receiving methadone maintenance treatment. It covers topics such as titration, stabilisation, interactions, loss of tolerance and shared care.
Download: http://www.smmgp.org.uk/download/guidance/guidance015.pdf (PDF 509KB)
Parenting capacity and substance misuse
Social Care Institute for Excellence, SCIE, 2005.
The topic of this briefing is how parenting capacity can be affected by parental substance misuse (drugs and/or alcohol) and how this may be managed.
Download: http://www.scie.org.uk/publications/briefings/files/scare06.pdf
Treatment outcomes: what we know and what we need to know
Gossop M. UK. National Health Service. National Treatment Agency for Substance Misuse, 2005.
(Treatment effectiveness 2). This paper reviews what has been learned from the following major national drug treatment outcome studies: NTORS (National Treatment Outcome Research Study); DARP (the Drag Abuse Reporting Programme); TOPS (Treatment Outcome Prospective Study) and DATOS (Drug Abuse Treatment Outcome Study).
Download: Full report (PDF 283KB)
Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention
WHO, 2004.
The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), have developed a joint position on substitution maintenance therapy for opioid dependence. Based on a review of scientific evidence and oriented towards policymakers, the WHO/UNODC/UNAIDS position paper covers a wide range of issues, from the rationale for this treatment modality, to the specific considerations regarding its provision for people with HIV/AIDS.
Download: http://www.who.int/substance_abuse/publications/en/
PositionPaper_English.pdf (PDF 499KB)
Confidentiality and information sharing
J Virgin. Developing drug service policies: Briefing No.1, NTA., DrugScope, 2003.
This briefing outlines definitions, good practice and current legislation with regard to confidentiality and information sharing for adult drugs services. It covers informed consent, when confidential information can be shared and in what circumstances confidentiality can be breached. It should be read with reference to briefing no. 2: Data protection and record retention.
Download: Full report (PDF 307KB)
Tackling crack - a national plan
Home Office, 2002.
The purpose of this plan is to build on best practice developed in those areas where positive action has already been taken to tackle the crack problem, and to prevent escalation in those communities most at risk.
Download: Full report (PDF 0.9MB)
International guidelines for the evaluation of treatment services and systems for psychoactive substance use disorders
WHO, 2000.
These guidelines summarise the main features of evaluation. The guidelines have four sections. Section 1 sets the stage for evaluation research and describes the importance of assessing the feasibility of a study in terms of the questions to be addressed, the resources required, ethical considerations and consultation with interested parties. Section 2 summarises the key features of the five main types of research evaluation: needs assessment, process evaluation, client satisfaction studies, outcome evaluation and economic evaluations. Section 3 describes reliability, validity and sensitivity of measures, reliability of self-report data, time periods for measures, assessing non-treatment factors that may affect outcome, subject recruitment and follow-up, sampling and sample size , and statistical analysis and testing. Section 4 offers guidance of report writing and ensuring results from evaluation studies are effectively presented to key audiences.
Download: http://whqlibdoc.who.int/hq/2000/WHO_MSD_MSB_00.5.pdf
