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Amphetamine prescribing

Community Addiction Unit, House 56, Cardiff Royal Infirmary, Newport Road, Cardiff CF24 0SZ

John Merrill and Lesley Peters

Drugs North West, Mental Health Services of Salford, Bury New Road, Prestwich, Manchester M25 3BL

Sir: We were interested to read of the survey by Moselhy et al about amphetamine prescribing (Psychiatric Bulletin, February 2002, 26, 61-62). In England and Wales, dexamphetamine is the second most commonly prescribed controlled drug, accounting for 4.4% of such prescriptions, with an estimated 900-1000 people receiving the drug as a harm reduction measure (Strang & Sheridan, 1997).

There is more extensive evidence than that cited by Moselhy et al for the efficacy of dexamphetamine, but this is largely based on opportunistic clinical evaluation. Recognising this deficiency, the Department of Health has funded a pilot (n=60) randomised controlled trial of dexamphetamine and best available treatment in Manchester and South Wales. The strict inclusion and exclusion criteria are both pragmatic and clinically relevant. We have used a modified version of the Opiate Treatment Index (Barrowcliff et al, 1999) to evaluate progress, supported by urine testing for continued use of street amphetamine. We would be interested to know if the services surveyed routinely tested their patients using this technique, which has been available for some time (Tetlow & Merrill, 1996). We have prescribed tablets only, as we have no evidence that these are crushed and injected.

In the absence of trial evidence we would agree that amphetamine prescribing should be restricted to specialist services. We intend that one of the outcomes of our study should be some clearer clinical guidelines for the treatment of dependent amphetamine users.

References

BARROWCLIFF, A., CHAMPNEY-SMITH, J. & McBRIDE, A. J. (1999) Use of a modified version of the Opiate Treatment Index with amphetamine users: validation and pilot evaluation of a prescribing service. Journal of Substance Use, 4, 98-103.

STRANG, J. & SHERIDAN, J. (1997) Prescribing amphetamine to drug misusers: data from the 1995 national survey of community pharmacies. Addiction, 92, 833-838.[Medline]

TETLOW, V. A. & MERRILL, J. (1996) Rapid determination of amphetamine stereo-isomer ratios in urine by gas chromatography—mass spectroscopy. Annals of Clinical Biochemistry, 33, 50-54.

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by McBride, A. Articles by Peters, L. Search for Related Content PubMed Articles by McBride, A. Articles by Peters, L.