This suggests that the recommendations regarding supervised consumption of methadone are impractical or widely ignored in England. Methadone is an opioid drug that is the most widely used drug treatment for opiate dependence National Consensus Development Panel, Methadone treatment is undoubtedly effective although there remains controversy over the relative benefits of maintenance long-term or detoxification treatment Ward et al, In England, unlike many countries, methadone has been commonly dispended to opiate addicts to take away and consume at home.
Many authorities recommend methadone maintenance doses of between 60 and mg although all responsible guidelines would recommend starting doses below 40 mg Department of Health, In the late s there were consistently more death from methadone overdose than from overdose of illicit heroin Royal College of Psychiatrists, Just over half of these deaths were due to diverted methadone—that is, methadone that had been sold to the victim on the black market.
Consequently the UK Department of Health and the Home Office both produced guidelines that recommend that methadone consumption should be supervised directly by a Pharmacist or other health professional for the first months of treatment Council on the Misuse of Drugs, ; Department of Health, This has lead to a significant reduction in the number of deaths related to methadone Ghodse et al, However the annual reports on drug related deaths in the UK indicates there are currently around methadone related deaths per annum — half of which are due to diverted methadone — that is methadone that is bought on the black market Ghodse et al, We chose to perform a survey of Community Pharmacies at several sites throughout the UK to survey the relative proportion of patients undergoing supervised methadone consumption.
Community Pharmacies were identified using the British Telecom telephone directories for 18 randomly selected districts in England.
Pharmacists were contacted by telephone in each area until either results were available for Pharmacies or data was available for at least 30 subjects on supervised methadone. Pharmacists were asked how many patients received methadone from them and how many had regular supervised consumption of methadone. No patient identifiable information was collected. Results were obtained from Pharmacies who dispensed methadone in the 18 English districts.
In total patients received methadone of whom were in receipt of supervised methadone - There remains some confusion amongst the various recommendations. The guidelines do make exceptions according to individual circumstances - usually interpreted as patients who are working and therefore unable to attend a Pharmacist during business hours. It would be helpful if these guidelines were consistent and there was a specific statement as to which patients should be excepted from supervised consumption. Supervised consumption is also recommended in patients who are receiving higher doses of methadone or those with other risk factors for drug-related deaths such as concomitant use of illicit drugs, prescribed benzodiazepines and alcohol misuse.
It is clear that recommendations regarding supervised consumption of methadone are either impractical or widely ignored. We have recently contacted community drug teams in England and Wales to ask what proportion of new patients on methadone undergo supervised consumption. This proportion is likely to be much higher in people who remain on methadone in the long term. This study also showed that users have significant opposition to the restrictions imposed by supervised consumption of methadone.
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