ABSTRACT
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Substitute prescribing is the prescription of the main drug of misuse or a drug from the same pharmacological group but of lower dependence potential to a dependent individual. The main purpose of substitute prescribing is to stabilize a person’s substance use and offer a period of time to work on non-drug-focused interventions. Slow reduction or detoxification can occur at any time during substitute prescribing. Recipients of substitute prescribing may fall into one or more of the following categories:
1. Diagnosis of opioid, cocaine, amphetamine, or benzodiazepine dependence 2. Minimum 6-month history of regular use 3. Regular injecting, especially if high risk, of whatever duration 4. Failed attempts to achieve abstinence 5. At time of initial assessment, likely to be at the pre-contemplation or contemplation stage of change
Evidenced-based guidelines for providing substitute treatment for drug misusers have been reported
and, in brief, aim to bring about:
Short term: Attract patients into treatment Relieve withdrawal symptoms
Long term: Retain in treatment
Reduce injecting behavior Stabilize drug use Stabilize lifestyle Reduce criminal behavior Reduce human immunodeficiency virus (HIV), HBV, and HBC transmission Reduce death rate
2.1 OPIOID-SPECIFIC PRESCRIBING
Maintenance prescribing differs from substitute prescribing only in that there is no active effort to bring about change in a person’s drug use or psychological state. The majority of clinical drug misuse services are concerned principally with the prescription of methadone to heroin users. American reviews tend to cite methadone as a direct pharmacological treatment in the way that insulin is used for diabetes. Many Europeans, however, would view methadone more as a substitute treatment whereby the improvements that are seen result from removing individuals from the process of using street drugs.
