The virtual disappearance of injectable opioids for heroin addiction under the ‘British System’

Aims: Injectable opioids were prescribed unsupervised under the 'British System' for heroin dependence. National guidelines (1999 and 2003) confirmed that injectable opioids have a legitimate 'limited clinical place' and should be dispensed daily, with 'mechanisms for supervision'. This study assesses whether national guidelines impacted on prescriptions of injectable opioids.

Methods: A 25 random sample of community pharmacists (n 2473) in England were surveyed by a questionnaire in 2005, with 95 response (n 2349). Opioid maintenance prescription data for anonymous patients (n 9620) were compared to the prescription data in 1995 (n 3721) from a matched survey.

Findings: Injectable opioid prescriptions reduced significantly from 10.5 (1995) to 1.8 (2005) of all opioid maintenance prescriptions. Daily doses significantly increased, as did daily dispensing from 28.8 (1995) to 57.8 (2005), whilst weekly dispensing reduced from 39.5 (1995) to 14.5 (2005). In 2005, injectable opioids accounted for 27.2 of private opioid prescriptions, versus 1.5 National Health Service (NHS) prescriptions. Private prescriptions were for larger take-home doses than NHS prescriptions. Regional variation was present.

Conclusions: Injectable opioid maintenance treatment for heroin dependence under the unsupervised 'British System' is disappearing, although not extinct. If injectable opioids are prescribed, this is more in line with national guidelines. However, many prescriptions are less than daily instalments.