Biomedical subjects

Tom Carnwath

Publications and source records attributed to Tom Carnwath.

3 recordsLinked to original sources

PubMed2002

Survey of doctors prescribing diamorphine (heroin) to opiate-dependent drug users in the United Kingdom.

AIM: To determine the scale and practice of diamorphine (heroin) prescribing for opiate dependence in the United Kingdom in 2000. DESIGN: Postal survey. SETTING: England, Scotland and Wales. PARTICIPANTS: One hundred and eleven of the 164 doctors in the United Kingdom on the Home Office record as holding a licence to prescribe diamorphine (response rate 68%), and 59 of the 108 doctors in the United Kingdom eligible to hold a licence (working in drug clinics), but not doing so (response rate 54%). MEASUREMENTS: The characteristics of doctors (a) holding a licence and (b) currently prescribing; the number of opiate users receiving a prescription; current treatment delivery, clinical criteria for patient eligibility; and reasons for prescribing or not prescribing diamorphine. FINDINGS: Seventy of the 111 doctors actually held a licence. While the majority were consultant psychiatrists, five were general practitioners. Forty-six were currently prescribing to 448 patients. The majority of prescribers reported that they had not initiated a prescription for diamorphine but had inherited patients already receiving such a prescription. Most of those who prescribed considered that in selected cases it could produce clinical and social improvement. There were great variations in clinical criteria for patient eligibility, prescribing practice, daily dose prescribed (range 5-1500 mg) and the daily dose-equivalent of 100 mg methadone (range 50-900 mg). Many respondents cited lack of appropriate resources as a reason for not prescribing to more patients. Reasons for non-prescribing varied from lack of resources to little evidence of its effectiveness. CONCLUSIONS: The prescribing of diamorphine to opiate dependent drug users remains rare in the United Kingdom. Not all eligible doctors seek a licence to prescribe, and not all those with licences actually prescribe it. There is no clear consensus on who should be treated with diamorphine and in what way.

Health Surveys↗

PubMed2002

The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence.

Patients with a severe mental illness such as schizophrenia have significant rates of concurrent amphetamine use. Such dual diagnosis patients have been shown to have poorer treatment outcomes. Often, they do not comply with treatment plans and have frequent episodes of hospitalization. There is growing evidence for the role of prescribed dexamphetamine in the treatment of amphetamine dependence. The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence has not been previously reported. Eight schizophrenic patients are described to whom dexamphetamine has been prescribed, with information being extracted retrospectively from case notes. In four out of eight cases, the prescription of dexamphetamine led to apparently good progress both in terms of substance misuse and psychiatric health. In two cases, progress was more equivocal, but appeared to produce some benefit. Two cases could be judged as treatment failures, but the condition and situation of the patients were not worse at the end of treatment than at the beginning. Compliance with neuroleptics increased in most cases. No patients exhibited exacerbation of psychosis as a result of treatment. The rate of outcome success is satisfactory when consideration is given to the difficult nature of this patient group, and their previous failure to respond to intensive treatment. It is argued that benefits may be gained from increased compliance with psychiatric treatment in patients prescribed amphetamine, and that this may outweigh possible risks. However, any conclusions are tentative in view of the nature of this study. A small open-label prospective study is recommended.

Adult↗

PubMedDate not supplied

Prescribing heroin.

Recent UK guidelines support the prescription of injectable heroin and methadone for opiate dependence, but many doctors disagree. Heroin has been prescribed in England for almost a hundred years, and the "British system" was once the subject of international curiosity. Since 1965, a prescriber licensing system has led to a great reduction in the proportion of opiate addicts treated with heroin. Recent trials in Switzerland and the Netherlands have prompted a review of British practice. It will probably remain somewhat different from continental practice, particularly with respect to long-term supervised injecting, but without adequate funding it may disappear altogether.

Drug Prescriptions↗