Aim: To assess the functioning of clients following cessation of diamorphine and gather views and experiences of that treatment episode.
Design: Audio-taped interviews and case note review. Qualitative analysis of semi-structured interview.
Setting: Gloucestershire specialist substance misuse service.
Participants: Seven of the original 29 clients who had diamorphine prescriptions terminated between June 2000 and November 2002 were interviewed. Case notes were reviewed for the three deceased clients.
Measurements: The General Health Questionnaire (12-item) was used together with a questionnaire containing structured and semi-structured parts to review current situation including substance misuse and health and their opinions of the diamorphine prescription and its cessation. Information gathered from notes included details of the diamorphine prescription and prior opiate use.
Findings: Three clients had higher psychiatric morbidity on the General Health Questionnaire. The majority was prescribed methadone. Two used no street drugs and three continued to use heroin. Three were in employment and two were homeowners. Five felt they had benefited from diamorphine but highlighted drawbacks including short half life and frequent appointments. The cessation was perceived as sudden, and without sufficient information. It was seen as causing changes in drug use, deaths and relationship breakdown. Two of the deceased clients died of opiate overdose. They had received detoxification rather than stabilisation on methadone.
Conclusions: Diamorphine prescribers need to be aware of the need to outline, clearly, the duration of treatment from the start, given the impact of stopping the treatment. Clients should be given adequate time, information and involvement.
Karen Williams, Consultant Psychiatrist
Conflicts of interest:
Conflict of Interest: None