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The need for speed: substitute prescribing to amphetamine users in Britain
Russell Newcombe, Senior Researcher, Lifeline Publications, Manchester
Abstract
The available evidence about the nature and effectiveness of substitute prescribing for amphetamine users in Britain is reviewed. Although use has dropped off significantly since the 1990s, amphetamine (speed) remains among our four most popular illegal drugs. Two national surveys in the mid-1990s found that over 100 treatment agencies and 400 pharmacies were involved in prescribing amphetamines to about 1,000 speed users, mostly within three health regions. The typical prescription involved a daily dose of 30-60mg of dexamphetamine tablets/syrup, dispensed on a weekly take-home basis. More recently, two regional studies have provided relevant evidence. Research into 16 North-West agencies treating speed users concluded that those prescribed dexamphetamine showed significant reductions in risk and harm compared with matched controls. A study of 29 treatment agencies in the Midlands found that two-thirds were prescribing dexamphetamine to speed users.
Relevant information has also been independently produced by 15 local treatment agencies, providing consistent preliminary evidence of the effectiveness of amphetamine prescribing on various indicators of harm reduction. These include: making and maintaining contact with speed users; providing them with various services; reducing illicit drug use, unsafe sex, and crime; and, minimising such harms as HIV, psychosis, illness, and death. It is concluded that guidelines for good practice in amphetamine prescribing to speed users should include strict criteria for inclusion, and an 8-point protocol covering attraction of clients, minimum waiting times, treatment plans, routine monitoring, multiple services, substitute drugs, weekly dispensing, and evaluation research. Independent long-term research employing control groups is urgently required.
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Biography
Russell Newcombe is a social psychologist, and has been a specialist researcher on drug use for 25 years. He helped launch the harm-reduction movement in Merseyside in the late 1980s - including pioneering work on needle exchange, substitute prescribing, and safer clubbing.
His main interests include harm reduction interventions, drug trends, and drug effects, and his various posts have included: Manager of the Mersey Drugs & HIV Monitoring Unit during the late 1980s; Director of 3D Research Bureau over the 1990s; Programme Leader of the MSc. in Drug Use & Addiction at Liverpool John Moore's University, 1998-2005; and Senior Researcher for Lifeline in Manchester since 2005. His books include 'Living with Heroin' (co-author 1988), 'The Reduction of Drug-Related Harm' (co-editor 1992), and 'Tripology - Guide to Mind-Bending Drugs' (writer 2005).
He has also published many academic papers in journals and edited works, and produced several leaflets/booklets on safer drug use for drug-takers. In 2007 he proposed a 10-point Charter of Drug Users' Rights, and in 2009 he completed his multi-disciplinary theory of drug-related harm reduction.
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