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Injectable Opioid Prescribing in Oxfordshire
- Joseph El-Khoury, Andrew McBride (16 April 2009)
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Joseph El-Khoury, Specialty Trainee 5 Oxfordshire and Buckinghamshire Mental Health Foundation NHS Trust, Andrew McBride
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Josephelkhoury{at}doctors.org.uk Joseph El-Khoury, et al.
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Dear Sir We sought to replicate the audit on the prescribing of injectable opiates undertaken by White and Shearman in Cornwall (Psychiatric Bulletin, October 2008, 32, 387-390). The Specialist Community Addiction Service covers the county of Oxfordshire. We identified 19 patients (14 Males and 5 Females) on regular injectable Opioid prescriptions: 10 Diamorphine (53%), 5 Methadone (26%), 2 Pethidine (11%) and 1 Morphine (5%). Of these, 17 were interviewed using a slightly modified version of the audit tool kindly provided by White and Shearman. Only one person had been started on a script in the last four years while others had been on this type of treatment for an average of 9.5 years (STD= 4.1). Three patients, all females, had been dependent on prescribed injectable opioid analgesics. The other 14 had been Heroin users for an average of 15.8 years (STD= 6.3) before being started on an injectable prescription. Compared with Cornwall, our audit reveals an older group of users who had been started on injectable scripts after lengthy periods of oral substitution treatment (9.2 years, STD= 6.1). The Oxfordshire cohort was also relatively more stable with no reports of overdoses whilst using the prescribed drug or additional opiate use in the previous month. Alcohol consumption was also low with only 2 clients reporting problematic levels of drinking. When asked, 47% said they had no intention to ever come off the script; 29% would consider it in 5 years and 24% in 1 year. The clients, regardless of the drug injected, were approximately evenly split between almost exclusive Intramuscular (IM) or Intravenous (IV) use with little crossover. Around half the patients reported experiencing any harmful physical consequences from prescribed injectable opiates. Occasional abscesses were the main problem faced by those injecting IM, while IV injectors reported abscesses, deep vein thrombosis and cellulitis. All had found access to medical care when needed. The overwhelming majority claimed to consistently use clean needles but the answers were more equivocal with regards to sterile injecting technique. Direct supervision of injecting techniques was minimal with only 2 clients (11%) remembering having been observed on one occasion by their GP or another health professional. In conclusion, we found interesting similarities between the client groups in Oxford and Cornwall which might indicate that a clinical rationale for providing injectable opiates to a niche population exists and that it transcends geographical and social regional differences. *Dr Joseph El-Khoury Specialty Registrar 5 in Adult Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Oxford Specialist Community Addiction Service, The Rectory Centre, Rectory Road, Oxford OX4 1DU. Tel: 01865455671, Fax: 01865455633 Email: Josephelkhoury@doctors.org.uk Dr Andrew McBride Consultant in Addiction Psychiatry, Oxfordshire and Buckinghamshire Mental Health NHS Foundation NHS Trust, Oxford Specialist Community Addiction Service, The Rectory Centre, Rectory Road, Oxford OX4 1DU Word count: 395 References WHITE, R., SHEARMAN L. (2008) Injectable Opiate Prescribing in Cornwall. Psychiatric Bulletin, 32, 387-390 |
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