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Heroin addiction is a significant health and social problem in England, and considerable investment has been made in treatment services in the past 10 years. Central Government funding for drug treatment has increased from £59 million in 2000/01 to £398 million in 2007/08, and 195 000 individuals were in treatment in 2006/7. Developing an evidence base for effective and cost effective interventions is therefore extremely important. The National Treatment Agency for Substance Misuse (NTA) was established in 2001 to improve the availability, capacity and effectiveness of treatment for drug misuse in England. The key initial task of improving access to treatment has now been achieved, and the focus has therefore moved to improving the quality of treatment and treatment systems. Contained within this change of emphasis is a move from harm reduction as the main focus of treatment towards more consideration of abstinence and recovery as achievable goals.
The current treatment system in England was developed to facilitate rapid access and maximise retention in treatment, mainly through effective prescribing interventions. Although research in the USA has identified different modalities of treatment, opioid substitution treatment (OST) is the predominant form of treatment in the UK. The efficacy of metha-done (and buprenorphine) treatment has been demonstrated in several systematic reviews, and the National Institute for Health and Clinical Excellence (NICE) has endorsed both drugs. OST can be effective in reducing illicit heroin use and other problem behaviours,1 and as such is an effective harm reduction strategy. However, the factors that are associated with such changes are not well understood. Increased doses of methadone produce reductions in illicit heroin use1 ,2 but what is less clear is the role of additional treatment services in addition to OST. One of the key rationales of OST is that by reducing craving and …
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