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PRACTICE: Stephen Pilling, John Strang, and Clare Gerada Psychosocial interventions and opioid detoxification for drug misuse: summary of NICE guidance BMJ 2007; 335: 203-205 [Full text]

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NICE Guidelines and opioid detoxification

Alasdair J Macdonald   (29 July 2007)

NICE or narrow-minded?

Woody Caan   (31 July 2007)

NICE Guidelines and opioid detoxification 29 July 2007
Alasdair J Macdonald, temporary consultant in child psychiatry Dorset County Hospital, Dorchester DT1 2JY Send response to journal: Re: NICE Guidelines and opioid detoxification	This is not a guideline. This is a manual for a form of treatment largely untested in the UK. It is significantly different from current practice in most UK substance misuse services. Surely NICE guidelines are meant to identify best practice, not to introduce completely novel treatment programmes. Competing interests: None declared
NICE or narrow-minded? 31 July 2007
Woody Caan, Professor of public health Anglia Ruskin University, Cambridge CB1 1PT, UK. Send response to journal: Re: NICE or narrow-minded?	BMJ wisely encourages more doctors to develop skills in drug detoxification, and adjunctive treatments to enhance acceptability and effectiveness. [1] What NICE calls ‘self help’ [1] (i.e. mutual aid groups) has a history of working alongside medical care for over 70 years. Weakness arises in the way NICE finds ‘evidence’. At the 1997 conference ‘Clinical effectiveness and patient centred care’ the embryonic Institute was presented. We were promised this Institute would not be swayed by fashion or favour, but would provide objective Overviews of best ‘practice’. In 10 years, mushrooming changes in medical publishing mean the ‘weight’ of evidence favours the most recent material regurgitated in many ephemeral papers. Impact factors are calculated over only 2 years: the time frame for fashions in publishing, as opposed to ideas that stand the test of time. For example, did NICE reviewers even consider the 1985 ‘NADA protocol’ for standardised acupuncture as an adjunct to methadone detox, or was 1985 before their time horizon? Within London, did these reviewers find reports on another, veteran adjunct: combined meditation and shiatsu massage? In Cambridge, both individual cognitive behavioural therapy [2] and group occupational therapy [3] were eminently compatible with detoxification. To forget the history of drug treatments [4] is to miss this lesson: patients seek and welcome collaborative care, centred on their multi-dimensional needs. Common social needs include validation and solidarity. For decades British drug users sought ‘psychosocial’ help within Therapeutic Communities. Research in both the UK (NTORS) and USA (DARP, DATOS) [5] found a reduction in heroin use with that most ‘unfashionable’ intervention. [1] Pilling S, Strang J, Gerarda C. Psychosocial interventions and opioid detoxification for drug misuse: summary of NICE guidance. BMJ 2007; 335: 203-205. [2] Dzialdowski A, London M, Tilbury J. A controlled comparison of cognitive behavioural and traditional counselling in a methadone tapering programme. Clinical Psychology & Psychotherapy 1998; 5: 47-53. [3] Buijsse N, Caan W, Fowler Davis S. Occupational therapy in the treatment of addictive behaviours. International Journal of Therapy & Rehabilitation 1999; 6: 300-307. [4] Caan W. The nature of herion and cocaine dependence. Pages 170- 195 in: Drink, Drugs and Dependence. From science to clinical practice. London: Routledge, 2002. [5] National Institute on Drug Abuse. Therapeutic Community. Research Report 02-4877. Bethesda: National Institutes of Health, 2002. Competing interests: About two decades of reviewing material on the 'treatment' of addiction for journals, publishers or service commissioners.