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Letters to the Editor
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Methadone
A challenging role but help is available
From Mr M. Bennett, FRPharmS
Further to Barry Sinclair’s letter (PJ, 3 April 2004, p414), may
I say that far from wishing to stifle debate about whether methadone
should be supplied from community pharmacies, I wish to encourage it.
However, I accept that there are community pharmacists who might be attracted
towards Mr Sinclair’s view that it should not. This is partly due
to experiences in the past where obtaining treatment for addiction was
almost impossible and the treatment available was usually a reducing
dose of methadone along with the threat of being thrown off the programme
should the patient transgress.
Over the past five years there have been major changes. The concept of
harm reduction and methadone maintenance treatment (MMT) has been embraced
by the Department of Health1 because the evidence shows this is the best
option around.2–6 It has also had an impact on reducing heroin-related
deaths.7 The focus now is on maintenance as a treatment in its own right,
rather than seeing it as a stepping stone to abstinence.
Given the evidence base for MMT, the next point of discussion is where
this treatment should be delivered. I think that supervised administration
of methadone can be delivered effectively from most community pharmacies
and that this is far more convenient for patients. I find it hard to
believe that even the smallest pharmacy would not be able to deal with
three or four patients and a typical pharmacy should have no problem
with seeing the equivalent of one per hour (say, eight patients). It
has also been clearly demonstrated that a specialist community pharmacy
can deal effectively with approaching 200 patients.8
I believe that additional training for staff should be made available,
that grants should be forthcoming to modify premises and provide improved
security, and that we should see this as an opportunity to become involved
in treatment. Here is a funded role that the Department of Health is
keen to see us develop. I predict that within a few years specialist
community pharmacists will be prescribing ongoing treatment for these
patients. It is a challenging role and not for the faint-hearted, but
help is available via the Centre for Pharmacy Postgraduate Education,
the National Pharmaceutical Association, local drug action teams and
the Royal College of General Practitioners substance misuse management
certificate course, among others. There is a lot of pharmacist experience
that can be accessed; members of the Private-Rx discussion forum (www.private-rx.com)
regularly discuss specific issues relating to treatment of drug addiction,
so it is easy to bounce ideas off fellow professionals.
A key point to consider is that some pharmacies are able to deliver this
service almost problem-free. There is a need to look at these and learn
how they do it.
Martin Bennett
Sheffield
References
1. Drug misuse and dependence: guidelines on clinical management. London:
HM Stationery Office; 1999.
2. Ward J, Mattick RP, Hall W. Methadone maintenance treatment and
other opioid replacement therapies. Amsterdam: Harwood Academic Publishers;
1998.
3. Ward J, Hall W, Mattick R. Role of maintenance treatment in opioid
dependence. Lancet 1999;353:221–6.
4. Bertschy G. Methadone maintenance treatment: an update. European
Archives of Psychiatry and Clinical Neuroscience 1995;245:114–24.
5. Ball J, Ross A. The effectiveness of methadone maintenance treatment:
patients, programs, services and outcomes. New York: Springer Verlag;
1991.
6. Keen J, Oliver P, Rowse G, Mathers N. Does methadone maintenance treatment
based on the new national guidelines work in a primary care setting?
British Journal
of General Practice 2003;53:461–7.
7. Gronbladh L, Ohland MS, Gunne L. Mortality in heroin addiction: impact
of methadone treatment. Acta Psychiatrica Scandinavica 1990;82:223–7.
8. Bellingham C. Coping with a large demand for CDs. Pharmaceutical Journal
2004;272:90. |
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