|
< BACK
Heroin prescribing
Stefan Janikiewicz, Clinical Director, Drug & Alcohol Services, Cheshire & Wirral Partnership Trust
Abstract
This presentation will be based on my experience of 30 years of prescribing in both General Practice and in a Specialist, Primary Care Led Treatment Unit where I have had some 18 years of involvement with heroin prescribed drug users.
The UK has had a long history of prescribing and this session will explain my understanding, as a GP, of prescribing since that time. The debate on what leads medical prescribing will be outlined and the influence of policy, economics and health determinants in driving the prescribing agenda will be discussed. In particular,reference will be made to how ‘methadone money’, the threat of an HIV epidemic and more latterly the potential impact of Hepatitis C have had, and are having on the direction of prescribing legislation.
Whilst the evidence for the efficacy of heroin prescribing remains equivocal, it is my contention that whilst science does not hold the answer, my personal experience has shown that a sound client/keyworker relationship, based on dignity and understanding may be of more relevance than the “prescription” in treatment outcomes. An outline is made as to how cocaine, benzodiazepines and alcohol have complicated treatment and care plans.
The conclusion asks why so many doctors having a diamorphine license fail to use it. I will offer some suggestions for the reluctance of some colleagues to use this therapeutic tool.
Recommendations for the future are based on my own experience.
TOP
Biography
Dr Stefan Janikiewicz has been a GP for 35 years, with a special interest in substance misuse. He is Clinical Director for the Drug & Alcohol Services within Cheshire & Wirral Partnership Trust, a position he has held for the past 17 years.
He was the first GP to head up a major drug treatment unit in England. He has clinical responsibility for community drug treatment, residential detoxification and harm reduction services in Wirral and has achieved 100% GP involvement in Shared Care in this locality. Wirral Drug Service in Wirral has recently been cited as an excellent service in the National Treatment Agency/Healthcare Commission Improvement Review and is recognised as one of the top performing services in the country.
He is a senior partner in a GP practice on the Wirral, held for 3 decades. His main interest has been Research Ethics and he has sat on Local, Regional and National Committees.
Dr Janikiewicz is a Clinical Lead in substance misuse for the Royal College of General Practitioners in North West England.
On a personal note, Dr Janikiewicz is married with eight children and runs daily in an attempt to stay sane…… (often unsuccessfully).
|
