The Pharmaceutical Journal
Vol 272 No 7302 p706
5 June 2004

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· Methadone maintenance
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Letters to the Editor

Methadone maintenance

British pharmacists should cherish role

From Dr R. Newman, MD

I realise plenty has been said already both for and against pharmacy dispensing of methadone. However, as an outspoken advocate of strong reliance on community pharmacists for the treatment of addiction, I must express my dismay over the letters published in the 6 March issue. All four commentators clearly express the sentiment that the goal of methadone maintenance is to achieve total, lasting abstinence. How can professional pharmacists, active participants in this treatment, be so misinformed?

In the 40 years since Nyswander and Dole first published their observations on methadone maintenance, the fundamental rationale for the treatment has been that, for many opiate-dependent individuals, “addiction” is a medical problem that defies “cure”. Can some achieve and maintain abstinence without need for ongoing medication? Of course, just as many (the majority) of people with adult-onset diabetes can overcome their “dependence” on insulin by compliance with a regimen of diet, exercise, etc. Your writers, however, view the patients to whom they administer methadone as failures — precisely because their physicians have determined that this medication is necessary and appropriate. It seems likely that the behaviour problems described are at least in part a response to this pejorative, illogical, contradictory judgement conveyed by the pharmacist.

In the US, the pharmacist has for almost 100 years been excluded by law from participating in the care of the disease of addiction. British pharmacists should cherish the role that they are privileged to play and ensure that they understand the treatment that they provide.

Robert Newman
Director
Baron Edmond de Rothschild Chemical Dependency Institute,
Beth Israel Medical Centre,
New York City

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