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Opioid Substitution Treatments

John Mann: To ask the Secretary of State for Health if he will undertake a study of the comparative advantages of using buprenorphine over methadone in opioid substitution treatments. [85039]

Ms Blears [holding answer 4 December 2002]: The Department's guidelines document—XDrug misuse and dependence—guidelines on clinical management" (1999) describes the principles required for safe and effective clinical practice. The guidelines also describe the use of buprenorphine with reference to the evidence base (including its advantages and disadvantages) both for substitution for detoxification and substitution for maintenance prescribing.

The national treatment agency for substance misuse (NTA) has a key role in considering and developing the research base for treatment and in disseminating evidence into practice. It has convened an on-going working group—the 'expert prescribing group' that meets regularly to consider treatment issues. Hence mechanisms are in place which allow the research agenda and evidence base to be kept under constant review.

Buprenorphine has a long history of use in the United Kingdom, but more recently, with increasing experience of use, as a substitute maintenance and detoxification treatment. The NTA is currently reviewing its research priorities and will continue to consider treatment issues as they develop.

Orthopaedic Care (Leeds)

Mr. Battle: To ask the Secretary of State for Health if he will make a statement on the length of time it takes to get (a) an appointment and (b) treatment in the orthopaedic departments in Leeds Health Trust. [81494]

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Jacqui Smith: The Leeds Teaching Hospitals Trust meets all NHS Plan targets with regard to referrals for out-patient appointments in orthopaedics. In September 2001, there were a total of 1,640 people who had waited longer than 21 weeks for an out-patient appointment in orthopaedics. In September 2002, there was nobody who had waited longer than 21 weeks. That represents a significant improvement.

The trust also meets the NHS plan target to operate on all orthopaedic patients within a maximum of 12 months.


Mr. David Stewart: To ask the Secretary of State for Health what representations he has received on the use of the drug Seroxat; and what research he has (a) commissioned and (b) evaluated on the effects of the drug. [83518]

Ms Blears [holding answer 2 December 2002]: The Medicines Control Agency (MCA) has received a range of representations including parliamentary questions, letters from hon. and right hon. Members, patients and health care professionals about the safety of Seroxat.

Seroxat (paroxetine) is a member of a group of drugs known as selective serotonin reuptake inhibitors (SSRIs). Before a product is granted a licence for use in the United Kingdom, satisfactory evidence of safety, quality and efficacy is required. After licensing, the safety of all medicines including SSRIs is continually monitored by the MCA and the independent expert advisory body, the Committee on Safety of Medicines (CSM) and any new evidence which emerges is carefully reviewed.

The MCA and the CSM carried out a major review of all side effects associated with SSRIs, which was completed in 2000 and resulted in product information for all SSRIs including Seroxat being updated and harmonised to reflect the common safety profiles of these medicines. An article in Current Problems in Pharmacovigilance in 2000 informed prescribers about this review and reminded them about the risk of withdrawal reactions.

Withdrawal reactions are an important and well-recognised side effect of Seroxat and also occur with the other SSRIs. The MCA/CSM warned prescribers about the possibility of withdrawal reactions associated with Seroxat via an article in the bulletin Current Problems in Pharmacovigilance in 1993. The CSM re-reviewed the issue of withdrawal reactions and possible dependence with Seroxat and the other SSRIs in 1998–99. From detailed review of all available data, which included spontaneous reports, published literature, clinical trials and usage data, the CSM concluded that all SSRIs may be associated with withdrawal reactions on stopping but on current evidence they are not associated with dependence. As a result of this review product information for all SSRIs was updated in relation to withdrawal reactions. This issue was also reviewed at a European level by the Committee on Proprietary Medicinal Products (CPMP) which reached similar conclusions.

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The product information for Seroxat which includes the summary of product characteristics for prescribers and the patient information leaflet contains details of side effects and warnings about withdrawal reactions. Doctors are advised to consider gradual tapering of dose when Seroxat is discontinued rather than abruptly stopping to avoid withdrawal symptoms.

The MCA/CSM is currently undertaking an intensive review of the safety of SSRIs, and in particular withdrawal reactions with Seroxat. When this is complete, any new advice will be communicated to prescribers and patients.

Specialised Services

Mr. Burstow: To ask the Secretary of State for Health pursuant to his answer of 27 November 2002, on specialised services, Official Report, ref 82780, if he will list the groups that attended the meeting on 10 September. [85391]

Mr. Hutton: The following organisations attended the national review group meeting on 10 September, considering commissioning arrangements for specialised services:

Sporadic CJD

Mr. John Lyons: To ask the Secretary of State for Health what the Government are doing to investigate sporadic CJD. [85388]

Ms Blears: One of the Department of Health-funded National Creutzfeldt-Jakob Disease Surveillance Unit's tasks is to identify and to investigate all cases of CJD, including sporadic CJD, in the United Kingdom by clinical examination, clinical investigations, neuropathological examination, genetic analysis, molecular biological studies, collecting basic epidemiological data and carrying out a case-control study. In addition, the UK is a member of the European and Allied Countries Collaborative Study Group, which is investigating the disease within and across European countries.


Accommodation Centres

Tony Baldry: To ask the Secretary of State for the Home Department (1) if the Independent Monitor of Accommodation Centres will be able to consider

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whether the location of a centre prevents a need of its residents from being met only once it has been built; [85015]

Beverley Hughes: Whether the location of an accommodation centre prevents a need of its residents from being met is a matter that can only be considered and assessed by the monitor once the accommodation centre is up and running. The monitor will not be involved in the selection of sites and there is no requirement for the Secretary of State to consult the monitor prior to establishing an accommodation centre. Decisions on the location of accommodation centres will be taken by the Secretary of State, subject to the planning process.

Part 2 of the Nationality, Immigration and Asylum Act 2002 makes provisions regarding accommodation centres. Under section 34, the monitor is required to monitor the operation of Part 2 of the Act, and in particular, to consider:

The monitor must report at least annually to the Secretary of State after the centres are up and running and the Secretary of State must lay a copy of the annual report he receives before Parliament as soon as is reasonably practicable.

If the monitor were to produce a critical report and identify a need of the residents of an accommodation centre which the location of the centre was preventing from being met, this would be one factor in the overall evaluation of the trial. If the monitor raised concerns with the Secretary of State, either in a formal report or before making his formal report, we would be able to consider whether those concerns required changes to be made.

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