UK methadone doses may not be high enough
On average, doses are less than 50mg |
Daily doses of methadone between 60mg and 120mg lead to improved outcomes but only a quarter of those in methadone treatment programmes receive these doses, according to a report published by the National
Treatment Agency for Substance Misuse.
The report is one of three briefings published for drug treatment providers
that cover methadone dose and maintenance treatment, counselling and
other psychosocial interventions, and engaging and retaining clients
in drug treatment.
The first reviews the evidence for appropriate methadone dosing. It concludes
that higher doses encourage users to stay on methadone treatment programmes
and reduce illicit drug use. “Lower dose levels may be undermining
the provision of optimal services,” it states and reveals that
in British methadone treatment programmes, doses are on average less
than 50mg daily.
Stuart Notman, a community pharmacist in Aberdeen, runs a methadone dispensing
service for over 150 clients. He told The Journal that the main goal
of treatment was to get clients off illegal drugs completely. “If
we can reduce the dose of methadone needed by any level then this is
also a success.” However, he added that to get someone off methadone
completely was difficult. “In the 14 years that this service has
been running, we have seen perhaps 4,000 to 5,000 different people. Only
six or seven have been able to come off and stay off,” he said.
Mr Notman suggested that pharmacists could act as an arbitrator between
methadone patients and their GPs to arrange changes to treatment where
appropriate. Pharmacists may know, or suspect, that a patient is topping
up their methadone dose with illicit drugs. He said that a good time
to approach a GP about changes to a patient’s methadone dose was
when the patient had returned to the pharmacy after several missed doses.
At this time, the dose may need to be lowered and then titrated back
upwards to a level that will help the patient avoid use of illicit drugs. “This
is a good negotiating point and a good time to influence the doctor’s
decision over dosage,” he said.
The National Treatment Agency briefings are available online at www.nta.nhs.uk |
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