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Letters to the Editor
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Methadone
A consistent formula is needed
From Mr R. Dunkley, MRPharmS
I dispense methadone in great quantities and to save space in my Controlled
Drugs cupboard I have started buying litres of diluent, syrup and sugar
substitute and gram pots of methadone powder. All one has to do is add
the powder to the diluent and what results is a litre of 1mg per ml methadone
mixture, which is what is required for drug addiction services.
I have never had so many complaints about the quality of the (home made) product — “it
does not hold me”, “it tastes funny” and “I was rattling
at 4.30am this morning”.
Even if I make the mixture up in front of customers and show them how it is
made (but use a bottle I made up earlier to dispense) it does not suffice.
The Drug Tariff formulary specifies that adding one to the other provides a
litre of methadone mixture DTF. What are the manufacturers doing? Why can they
not get a common formula? I suspect it is in the preservative, as my addict
patients complain of the taste. “Ooh, it’s like Lockets” is
one complaint I hear many times.
The manufacturers of the “ready made” are not off the hook — changing
from one brand to another brings accusations that you are watering it down.
Can there not be one formula that is consistent between manufacturers, with
exactly the same ingredients? In the meantime, I and my colleagues in substance
misuse management must take the flak from addicts who, having made a decision
to change their lives, are being a dispensed a product that does not meet their
needs.
Bob Dunkley
Dewsbury, West Yorkshire
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The
Pharmaceutical Journal