Updated guidelines aid substance abuse, addiction treatment
MedWire News: Updated guidelines designed to offer practical advice for clinicians to optimize clinical decision-making for the treatment of substance abuse and addiction have been published by a leading UK society.
The British Association for Psychopharmacology (BAP) first published guidelines for the pharmacologic management of substance misuse, addiction, and comorbidity in 2004. For the current update, a panel of BAP experts identified relevant systematic reviews and meta-analyses, and examined recent documents from the UK National Institute for Health and Clinical Excellence and other organizations.
Anne Lingford-Hughes, from Imperial College London, UK, and colleagues focused on individual and societal aims of patient management, emphasizing a shared understanding between the patient and prescriber. These included withdrawal syndromes, relapse prevention and the maintenance of abstinence, reduction of harms associated with illicit drug use, and the prevention of the complications of substance use, such as Wernicke's encephalopathy and Korsakoff's syndrome.
The experts set out recommendations for the management of alcohol misuse, opioid dependence, benzodiazepine dependence, the use of stimulant drugs (including cocaine, crack, methamphetamine, and amphetamine), the use of "club" drugs (ecstasy and gamma-hydroxybutyric acid), polydrug use, nicotine dependence, and the complications associated with pregnancy and comorbidities, such as schizophrenia and bipolar disorder.
The team highlights important areas of the main uncertainties that are designed to further assist the development of treatment goals that can be agreed on by both the treating clinicians and their patients. The researchers have also produced a series of best practice advice that incorporates both the assessment and pharmacologic management of these situations, including treatments in common clinical use and those with promising evidence.
The team writes: "Our aim is to provide helpful and pragmatic guidelines for clinicians such as psychiatrists and [general practitioners] involved in prescribing to people with substance abuse or harmful use or addiction alone and with psychiatric comorbidity.
"However, the update should also be of interest to other practitioners in the substance misuse field, non-specialists, patients and their families."
The authors add in the Journal of Psychopharmacology: "We also suggest seeking appropriate support and supervision from peers and clinical governance if required, since many of the medications described do not hold a licence for the indication under discussion in UK, though may in other countries."
By Liam Davenport