From Mr A. M. Crabbe, FRPharmS
SIR,-Where are we going with the consumption of methadone within pharmacies? What are we hoping to achieve?
To give some help in producing an answer to my question, let me say that I have been supervising methadone consumption for several years now, certainly from the first time that it was undertaken in the old Mid Glamorgan. Protocols were agreed between the local pharmaceutical committee and the community drug and alcohol team. I understood and indeed still understand the rationale behind supplying methadone in order to help overcome the need for other drugs and the social consequence of people committing both petty and serious crimes to get the money to satisfy an addiction. But where are we going?
At present we have nine patients coming into the pharmacy daily to consume their methadone. Every day, the pharmacists involved in supervising these patients talk to them, cheer them up, counsel them. All of the patients, without exception, wish to kick the habit. How do you counsel a young women who has several children, has had part of her forearm amputated and who has had a hysterectomy before the age of 28? How do you counsel, how do you explain when a 19-year-old girl dies alone in the public toilet of a supermarket?
I have been a pharmacist long enough to remember when my role was to help to promote healing and reduce suffering. I know time has moved on and roles have changed and I am pleased that they have. Indeed, I hope that I have been a part of that change. But following that older ideal, we should all be involved in not just reducing the social disturbance caused by addiction but in helping to minimise addiction itself.
We have had patients who, after periods of reducing methadone, have been included in a "detox" programme. Leading up to the time that they are admitted we, the pharmacists, talked to them, cajoled them, persuaded them and sympathised with them when they were having a bad day. But when they are discharged, they go back into the community where their friends are other people misusing substances and consuming methadone. What chance do they have? Why is there no after care? It might be that the greatest service that we could provide for anyone following detox treatment is to insist that they move away from home.
How should we react to a patient who is reducing his or her daily consumption when along comes a boy- or girl-friend, not included in the methadone programme, who gets needle exchange kits from the pharmacy. Soon afterwards the daily dose of the original patient is increased. It is not difficult to draw conclusions. Are we wasting their time, my time and money that could be used more wisely? I ask the question again. I really do not know the answer.
Where are we going? I want to help. I am a pharmacist and it is what I do best. But just getting these kids into a pharmacy day after day is not sufficient.
Alan Crabbe
Cardiff