Sir: We were interested to read of the survey by Moselhy et al about amphetamine prescribing (Psychiatric Bulletin, February 2002, 26, 61-62). In England and Wales, dexamphetamine is the second most commonly prescribed controlled drug, accounting for 4.4% of such prescriptions, with an estimated 900-1000 people receiving the drug as a harm reduction measure (Reference Strang and SheridanStrang & Sheridan, 1997).
There is more extensive evidence than that cited by Moselhy et al for the efficacy of dexamphetamine, but this is largely based on opportunistic clinical evaluation. Recognising this deficiency, the Department of Health has funded a pilot (n=60) randomised controlled trial of dexamphetamine and best available treatment in Manchester and South Wales. The strict inclusion and exclusion criteria are both pragmatic and clinically relevant. We have used a modified version of the Opiate Treatment Index (Reference Barrowcliff, Champney-Smith and McBrideBarrowcliff et al, 1999) to evaluate progress, supported by urine testing for continued use of street amphetamine. We would be interested to know if the services surveyed routinely tested their patients using this technique, which has been available for some time (Reference Tetlow and MerrillTetlow & Merrill, 1996). We have prescribed tablets only, as we have no evidence that these are crushed and injected.
In the absence of trial evidence we would agree that amphetamine prescribing should be restricted to specialist services. We intend that one of the outcomes of our study should be some clearer clinical guidelines for the treatment of dependent amphetamine users.
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