The Pharmaceutical Journal
Vol 270 No 7246 p573
26 April 2003

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Letters to the Editor

Drug addiction

Treating patients with dual opiate and alcohol addiction

From Dr J. Guirguis, MRCPsych, and Mrs M. F. Nasr, MRPharmS

Methadone has been used to treat opiate dependence since the early 1960s.

Nowadays, with the rise of number of patients receiving treatment, addiction treatment units have become increasingly reliant on community pharmacists in dispensing methadone and other Controlled Drugs. The role of pharmacists has steadily progressed, especially with the development of supervised consumption and the need to liaise closely with the prescribing doctors.

Since more patients with dual addiction (opiate and alcohol) are prescribed methadone, many of whom are not showing symptoms of alcohol intoxication (due to the intensity of the dependence and the development of tolerance), it is wise to check the Alcometer reading (an Alcometer is a simple machine which measures the level of alcohol in the patient's breath) before the first dispensing and sporadically thereafter.

If the reading is unacceptably high, the pharmacist should discuss the suitability of dispensing methadone with the patient's care co-ordinator and decide the course of action accordingly.

Through doing so, the care co-ordinator will be kept abreast of the patient's possible dual dependence and the patient will be saved from the hazardous interaction that ensues from concomitant use of alcohol and methadone.

The whole process of breath testing and reporting the results should be included in the protocol between the hospital and the dispensing pharmacist, and in the care programme approach signed by the patient and the treating team.

Joseph Guirguis
Specialist Registrar in Addiction
Wotton Lawn Hospital,
Gloucester

Marian Nasr
Lloyds Chemist,
Birmingham

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