Dexamphetamine prescribing in a community drug team

We conducted a retrospective case note review, looking at dexamphetamine prescribing in the service over 12 years (1993-2005). Of the 32 patients 8 (25%) were still active in treatment and 24 (75%) cases were closed. Of the closed cases1 (3.1%) died, 8 (25%) were discharged after agreed gradual withdrawal of dexamphetamine and 15 (46.9%) dropped out. There were different referring agents: 18 were self-referral, 5 from GP, 4 from psychiatric teams, and 5 from other community drug teams. The mean age was 37.4 years, and the male/female ratio was 62.5%/37.5% with no statistical difference between the 2 sexes in any of the variables. In all, 90.6% were White British, 6.3% were African-Caribbean, and 3.1% were Asian. Thirteen (37.5%) patients were single, 5 (15.6%) were married, 6 (18.8%) were divorced, and 9 (28.1%) were cohabiting. The main route of use was oral (18 patients) and injecting (14 patients). Out of the sample, 25 (78.1%) patients never shared equipments and 7 (21.9%) shared equipments. Average dose of illicit amphetamine was 1.7 g (SD=1.3) per day. Five patients suffered comorbidity of severe mental illness and amphetamine dependence. After commencing dexamphetamine and stabilizing the dose all the 5 patients reported improvement in their psychotic symptoms. The 32 patients were prescribed dexamphetamine, at an average dose of 24.5 mg. The 32 patients remained in contact with the team for nearly 2 years. These findings offer emphasis on the importance of substitute medications as an important form of treatment and retaining the patient with the drug service.