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Misuse of drugs and other substances Implementing NICE guidance 2 nd edition December 2012 NICE public health intervention guidance 4 Clinical guidelines.

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Presentation on theme: "Misuse of drugs and other substances Implementing NICE guidance 2 nd edition December 2012 NICE public health intervention guidance 4 Clinical guidelines."— Presentation transcript:

1 Misuse of drugs and other substances Implementing NICE guidance 2 nd edition December 2012 NICE public health intervention guidance 4 Clinical guidelines 51 and 52

2 Guidance reviews CG51, CG52 and PH4 Guidance issue date: 2007 Review date: review recommendations CG51, CG52 and PH4 will not be updated at this time CG51: two clinical trials on contingency management are expected to publish results in 2012 and 2013 PH4: a future review may consider the broader prevention of substance misuse – including alcohol

3 What this presentation covers NICE Quality standard for drug use disorders NICE and the National Treatment Agency (NTA) Background Principles of person centred care/supporting families and carers Key recommendations NHS evidence and NICE pathway Find out more

4 Quality standard for drug use disorders Published: November 2012 Includes quality statements and indicators on: 1 Needle and syringe programmes 2 Assessment 3 Families and carers 4 Blood-borne viruses 5 Information and advice 6 Keyworking – psychosocial interventions 7 Recovery and reintegration 8 Formal psychosocial interventions and treatments 9 Continued treatment when abstinent 10 Residential rehabilitative treatment

5 NICE and the National Treatment Agency (NTA) NICE guidance was incorporated into Drug misuse and dependence – guidelines on clinical management: update 2007 (the Orange book) Contingency management demonstration sites NICE guidance and implementation tools

6 Guidance this presentation covers NICE public health intervention guidance: Interventions to reduce substance misuse among vulnerable young people (PHI4) NICE clinical guideline: Drug misuse: psychosocial interventions (CG51) NICE clinical guideline: Drug misuse: opioid detoxification (CG52) NICE technology appraisals on methadone and buprenorphine (TA114) and naltrexone (TA115) for the management of opioid dependence We also refer to Drug misuse and dependence – guidelines for clinical management: update 2007 (the Orange book), as it incorporates NICE guidance

7 Background 327,000 people use opioids and/or crack cocaine in the UK People who misuse drugs may have a range of health and social problems Drug misuse has a negative impact on physical and mental health and social functioning Correct at This slide was not updated for the 2 nd edition

8 Principles: Person-centred care People who misuse drugs should be given the same care, respect and privacy as any other person. Treatment and care, and the information service users are given about it, should be culturally appropriate. It should also be accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.

9 Principles: Supporting families and carers If the service user agrees, involve families and carers in decisions about treatment and care Offer family members and carers an assessment of their personal, social and mental health needs Provide information about : – impact of drug misuse on service users, families and carers – self-help and support groups for families and carers

10 Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people NICE public health intervention guidance 4 March 2007 Public health guidance PHI4

11 Definition: substance misuse Intoxication by – or regular excessive consumption of and/or dependence on – psychoactive substances, leading to social, psychological, physical or legal problems It includes problematic use of both legal and illegal drugs (including alcohol when used in combination with other substances) PHI4

12 Definition: vulnerable and disadvantaged Children and young people aged under 25 and at risk of misusing substances; among the most vulnerable are: those whose family members misuse substances those excluded from school, and truants young offenders those involved in commercial sex work PHI4

13 Key recommendations: children and young people Develop a strategy Identify those at risk Provide community-based interventions PHI4

14 Develop a strategy Develop and implement a strategy to reduce substance misuse among the target population, as part of a local area agreement Target populationWho should take action? Any child or young person under 25 who is vulnerable and disadvantaged Local strategic partnerships PHI4

15 Use existing screening and assessment tools to identify the target population who are misusing – or who are at risk of misusing – substances Work with parents or carers, and other relevant professionals Identify those at risk Target populationWho should take action Any child or young person under 25 who is vulnerable and disadvantaged All who work with vulnerable and disadvantaged children and young people PHI4

16 Offer a family-based programme of structured support over 2 or more years, drawn up with the parents or carers and led by staff competent in this area Offer more intensive support to families who need it Interventions: family support Target populationWho should take action? All who work with vulnerable and disadvantaged children and young people Any child or young person aged 11–16 assessed to be at high risk of substance misuse Their parents or carers PHI4

17 Offer the children group-based behavioural therapy over 1–2 years, before and during the transition to secondary school Offer the parents or carers group-based training in parental skills Interventions: behavioural therapy Target populationWho should take action? Practitioners trained in group-based behavioural therapy Children aged 10–12 who are persistently aggressive or disruptive and assessed to be at high risk of substance misuse Their parents or carers PHI4

18 Offer one or more motivational interviews according to the young persons needs. Each session should last about an hour. Interventions: motivational interviews Target population Who should take action? Practitioners trained in motivational interviewing Vulnerable and disadvantaged children and young people aged under 25 who are problematic substance misusers PHI4

19 Clinical guidelines Drug misuse: opioid detoxification (CG52) NICE clinical guidelines 51 and 52 July 2007 Drug misuse: psychosocial interventions (CG51) CG51 & 52

20 Organising and developing care Identifying people who misuse drugs Assessment Key recommendations CG51 & 52 Clinical guidelines

21 Organising and developing care At initial contact/formal reviews, explain options for abstinence-oriented, maintenance-oriented and harm- reduction interventions Discuss with people who misuse drugs whether to involve families and carers in their assessment and treatment plans Ensure that there are clear plans to facilitate effective transfer of people who misuse drugs between services, to reduce loss of contact CG51 & 52

22 Identifying people who misuse drugs In mental health and criminal justice settings, routinely ask service users about recent legal and illicit drug use: type, method of administration, quantity and frequency In settings such as primary care, general hospitals and emergency departments, consider asking people about recent drug use if they have symptoms that suggest the possibility of drug misuse CG51 & 52

23 Initial assessment When making the assessment and developing and agreeing a care plan, consider the service users needs, drug use and treatment history, goals and preferences Agree the care plan with the service user Use biological testing as part of a comprehensive assessment of drug use CG51 & 52

24 Assessment for opioid detoxification Assess people presenting for opioid detoxification to establish the presence and severity of opioid dependence and use of other substances If opioid dependence or tolerance is uncertain, normally use confirmatory laboratory tests in addition to near- patient testing Near-patient and confirmatory testing should be conducted by appropriately trained healthcare professionals CG52

25 Key recommendations Drug misuse: psychosocial interventions Brief interventions Self-help Contingency management CG51

26 Opportunistic brief interventions focused on motivation should be offered to people in limited contact with drug services if concerns about drug misuse are identified Brief interventions These interventions should: normally consist of 2 sessions each lasting 10–45 minutes explore ambivalence about drug use and possible treatment CG51

27 Staff should routinely provide people who misuse drugs with information about self-help groups Self-help These groups should normally be based on 12-step principles; for example: Narcotics Anonymous Cocaine Anonymous CG51

28 Drug services should introduce contingency management programmes as part of the phased implementation programme led by the NTA Contingency management Aim: to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment harm reduction for people at risk of physical health problems resulting from their drug misuse CG51

29 Key recommendations Drug misuse: opioid detoxification Provide information, advice and support The choice of medication for detoxification Do not offer ultra-rapid detoxification Care settings for detoxification Types setting Choice of setting Criminal justice system CG52

30 Detoxification should be a readily available treatment option for people who are opioid dependent and have expressed an informed choice to become abstinent In order to obtain informed consent, staff should give detailed information to service users about detoxification and the associated risks Provide information, advice and support CG52

31 The choice of medication for detoxification Methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification When deciding between these medications, healthcare professionals should take into account: current maintenance treatment with methadone or buprenorphine the preference of the service user NICE has produced two technology appraisals on: methadone and buprenorphine (TA114) naltrexone (TA115) CG52

32 Ultra-rapid detoxification under general anaesthesia or heavy sedation (where the airway needs to be supported) must not be offered This is because of the risk of serious adverse events, including death Do not offer ultra-rapid detoxification CG52

33 Settings of care Community Residential Inpatient Criminal justice system CG51 & 52

34 Staff should routinely offer a community-based programme to all service users considering opioid detoxification Exceptions may include service users who: have not benefited from previous formal community-based detoxification need particular medical and/or nursing care require complex polydrug detoxification are experiencing significant social problems The choice of setting for detoxification CG52

35 Settings: criminal justice system Access to and choice of treatment for drug misuse should be the same whether people participate voluntarily or are legally obliged to do so Prisons Treatment options, including detoxification, should be comparable to those in the community Consider offering access to a therapeutic community for treating drug misuse in prison Consider residential treatment for people who have decided to remain abstinent after release CG51 & 52

36 NICE technology appraisals Methadone and buprenorphine for the management of opioid dependence (TA114) Naltrexone for the management of opioid dependence (TA115) TA114 & 115

37 Methadone and buprenorphine Are recommended as options for maintenance therapy in the management of opioid dependence The choice of drug should be made on a case by case basis - methadone should where possible be first choice Administration should be daily and under supervision for at least the first 3 months TA114

38 Naltrexone Is recommended as a treatment option in detoxified formerly opioid-dependent people Should only be administered under adequate supervision and as part of a programme of supportive care The effectiveness of using naltrexone as a treatment should be reviewed regularly TA115

39 NICE Pathway Click here to go to NICE Pathways website Provides details on the provision of needle and syringe programmes for adults who inject illicit substances

40 NHS Evidence Visit NHS Evidence for the best available evidence on substance misuse care Click here to go to the NHS Evidence website

41 Find out more Visit for:www.nice.org.uk/guidance/QS23 NICE Quality standard for drug use disorders NICE support for commissioners and others Information for people using NHS services for drug use disorders For NICE guidance and supporting costing and audit tools visit:

42 What do you think? Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form.short evaluation form If you are experiencing problems accessing or using this tool, please To open the links in this slide set right click over the link and choose open link


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