Amphetamine

Just a brief note that the Advisory Committee on the Misuse of Drugs has published a document reviewing amphetamines and particularly methylamphetamine. The document is long and very detailed, looking at history, manufacture, adverse effects and treatment amongst other things. The document is perhaps the most useful thing I have read on this subject for a long time.

SSAD

The Society for the Study of Addiction held it's annual meeting yesterday and today - the title "If we did have evidence based policy and practice, what would they look like?"
I'm afraid that there weren't too many clear answers to the question - largely because policy is in the hands of the policy makers.

Alcohol was a case in point - there is now a large body of evidence (UKATT and Project Match) to support brief interventions in people with hazardous or problematic drinking, but policy is slow to support with funding for these brief interventions, perhaps because the alcohol industry is at the table when it comes to formulating alcohol policy. Anyway, one thing that came out of Jane Marshall's excellent talk was that I bought a book she has co written about alcohol treatments. Perhaps I will report back on this in the future.

Robert West spoke admirably on the evidence for effective quit smoking strategies. He reminded me that in people with low seizure risk bupropion is an option and that although unlicenced, in the person not at risk of OD, nortriptyline 75-150mg has been shown to be effective. Nicotine replacement therapy is effective, and although it is not licenced, he suggested that an acute delivery system could be co-prescribed with a chronic delivery system, eg gum and patches together! Telephone councelling of the proactive sort has some benefit but reactively is not useful. The best results are achieved with combining either NRT or bupropion/nortriptyline with behavioural support and can achieve a 15% cessation rate at 6 months. He added the titbit that there is some evidence that those who suddenly decide to quit mid pack seem to do better than those who decide and set a date, so that our smoking cessation clinics need to be able to respond to such an individual who is suddenly in need of support. Finally he mentioned 2 new drugs that might be heading our way - Varenicline - a "false tobacco" and Rimobant.

In the short papers section Duncan Raistrick presented on a comparison of lofexidine vs buprenorphine detoxification. There was little to chose between the two but the service users voted with the feet and those who refused randomisation elected for buprenorphine. Nicky Metrobian and Nick Lintzeris presented information on injecting rooms in London. These are just being established and a trial of effectiveness in process. Intriguingly they claimed that in toxicological screens they could distinguish between street and prescribed heroin, but gave no further details on this.

An overdose of training

Several useful training courses arose together in the last 2-3 weeks, hence my postings have gone down because I have been too busy. Here is a digest of what went on.
4th of November - the RCGP launched its' methadone guidance in London. The meeting and guidance confirmed that my practice is within the new guidance, rather than adding much in the way of the new information, so was useful for that.
3rd of November - this was the twice yearly meeting of my local RCGP Action Learning Set. We networked and discussed recent changes in policy direction. Non medical prescribing was touched on - I think that there were differences of opinion about how appropriate this was in the field of drug dependence and in the wider field of medicine. Interestingly, I think the most negative views came from the one non medic in the room! We discussed the way that the criminal justice system has developed drug treatment schemes and how various different patient groups might access services through these schemes. A colleague produced a flow chart which really filled in my understanding of this area. Finally we had an interesting case presentation about a young person with an alcohol problem. We discussed how difficult it was to access formal inpatient alcohol treatment services for young people and the risks of mixing them up with inpatient drug treatment services.
October 17th (RCGP) and November 5th (NKPCT) saw me attend 2 seperate events on "GP Appraisal". I really felt the need to "up my game" with appraisals after a recent appraisal just felt flat, so that was my motivation for attending the training. The RCGP event was an advanced appraisal training event and the NKPCT event was aimed at improving Personal Development Plans. The RCGP event went reasonably well, although there was a mix of experience appraisers, some who had never appraised and some like myself with a few appraisals under my belt. What I learnt was that it was important for me to review my appraisal technique before each appraisal, as it was easy to forget the process especially if there was a month or two passed since my last appraisal. To this end I have produced a simple 2 page reminder document to enable me to quickly revise before I appraise. The NKPCT event was much more focussed on Form 4 and the PDP. It reminded me of the value of looking at Form 4 in the light of the evidence that the appraisee has submitted in his/her written material and in the interview. I think I will be able to use this to develop more focussed PDP's in the future.