All opiate addicts being newly treated with methadone should have to take their methadone under daily supervision for at least six months, the Advisory Council on the Misuse of Drugs has said.
In a report to Ministers published on June 26, the ACMD sets out a review of the possible levels and causes of deaths due to drugs misuse and possible actions to reduce them. Among these actions is a recommendation that methadone treatment should be closely supervised to be reduce the illicit availability of the drug.
The report says that there were about 30,000 people receiving methadone maintenance treatment in England and Wales in 1995 and that deaths in this group were increasing. The committee says that action to reduce methadone-related deaths should be a priority component in any action to reduce drug-related deaths overall.
As well as recommending more supervision, the report says that pharmacists and others involved in the methadone supply chain should communicate the risks of the product more clearly and that labels on dispensed methadone should include clear warnings, particularly in relation to unintended consumption by children.
Because methadone has a narrow window of clinical safety, the committee recommends that the Department of Health should plan trials on alternative treatments for opioid addiction as a matter of urgency.
One problem with which the committee had to grapple, and which the report's preface makes clear, is that data on drug-related deaths are unreliable. The closest the committee could come to identifying the magnitude of the problem was to say that deaths in England and Wales due to overdose in 1998 were between 1,076 and 2,997. These numbers did not take account of deaths caused by virus infections acquired as a result of drug abuse or deaths from related motor vehicle accidents or criminal violence. The committee took the view that deaths due to drug-related virus infections would soon exceed those from overdose or other immediate effects of drug use. It recommended changes to the format of certificates to be issued by coroners after inquests in order to make the data more accurate.
In a statement welcoming the report, Ms Gisela Stuart (Parliamentary Under-Secretary of State for Health) said that health authorities had been given an additional £12m last year and £18m this year to develop services for drug misusers. Priority was being given to supervised consumption schemes for methadone and improving the knowledge and skills of primary care staff.
"Reducing drug related deaths: a report of the Advisory Council on the Misuse of Drugs." The Stationery Office, ISBN 0-11-341239-8, price £11.50.