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Fact sheet

Drug Misuse and Dependence: UK Guidance

The 2007 Clinical Guidelines on Drug Misuse and Dependence (or ‘Orange Book’) provide guidance on treatment for drug misusers for all clinicians in the UK, particularly those in Drug Action Teams (DATs). While these are not legal guidelines, if clinicians stray from them, they must be able to demonstrate the rationale for their decisions.

A key principle of the Orange Book states that while the clinician's focus must be on the patient themselves, the impact of the patient's drug misuse on other individuals (i.e. carers and dependent children) should be taken into consideration (point 1, p.11). From this, there are a number of relevant areas of which Carers' Centres should be aware when working with carers for people with any substance misuse problem:

  • The Orange Book recognises carers’ and families’ needs for information and support and states that that these “needs should not be overlooked” (point 1.5.6, p.14; also point 2.1, p.17). The Book is clear that “bearing in mind the patient’s right to confidentiality…information should be exchanged both ways between clinicians and carers and carers should be active partners in drug misuse treatment” (point 2.7, p.23). As such, the Book includes a list of the specific information, advice and support that should be given to the carer by clinicians, including information on local carer support, the impact of drug treatment and family therapy (point 2.7, p.23, see also point, p.38). Remind any drug and alcohol workers or other colleagues of these responsibilities if you consider that they are being unnecessarily obstructive to the carer.
  • In addition to this list, Patient Group Directions (PGDs – see point 2.4.4, p.21) are written instructions for the administration of particular medicines to patients with a defined diagnosis, condition or need. Examples of PGDs relevant to drug misuse include: hepatitis vaccination, antibiotics for infections and take-home emergency naloxone. It may be useful to ask for this information for a carer if it has not been provided.
  • The Orange Book also states that “children [of drug misusers] have a right to express their views and to have them taken into account when decisions are made about what should happen to them” (point 2.5.3, p.22; see also point 3.2.2, p.28). So, if young carers are not being involved in decisions that affect them, direct the clinician’s attention to this part of the guidance!

Drug Misuse and Dependence: UK Guidelines on Clinical Management (the Orange Book)