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Letters to the Editor
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Drug misuse
DORIS study — anti-methadone propaganda
From Mr D. Garratt
I am writing in response to your news
item that detailed the findings of the recent Drug Outcome Research in Scotland study (PJ, 4 November,
p539). This study questions the efficacy of methadone as an effective
maintenance therapy for opioid-dependent users.
Methadone is one of the most highly researched medicines available and
is widely upheld to be the gold standard in maintenance prescribing.
Therefore, when analysing these findings, some pertinent questions need
to be asked.
Of those users interviewed, how many were stabilised on an optimal (60–120mg)
dose of methadone? Recent figures from England suggest that average doses
are still 56.7mg (National Treatment Agency, June 2006). Therefore, it
is extremely plausible that many of the research cohort may have continued “topping
up” their methadone in order to ease the discomfort of withdrawal
due to their sub-therapeutic level of care.
How many of the users interviewed identified abstinence from all drugs,
except their medicine, as a goal in their individualised and regularly
reviewed care plan? Was this ever intended to be a desired outcome for
the patient, or just the researchers? It is perfectly acceptable, and
largely accepted, that many maintained users will want to continue using
heroin in a significantly reduced and controlled way on top of their
prescription, and why should they not? The intention of an effective
maintenance programme is to enable users to progress, reduce chaos and
unnecessary risk in their lives, achieve stability and support reintegration
and change. It is not about ending all illicit drug use per se.
Surely, a more effective measure would have been to assess how methadone
maintenance programmes had reduced incidents of (non) fatal overdose,
affected drug-seeking behaviours, reduced criminal activity, improved
mortality rates and improved employment options — tangible measures
that support the efficacy of methadone maintenance treatment.
My big worry is that many of our pharmacist colleagues will read these
findings and conclude that methadone does not work, which would do a
great disservice to the immeasurable numbers of users who have benefited
and survived thanks to the increasing therapeutic alliance between users,
prescribers, their key workers and pharmacists.
Ineffective, unco-ordinated treatment regimens need to be highlighted
since these inhibit users’ progress. I hope your readers accept
these findings as anti-methadone propaganda and not a true reflection
of effective drug treatment.
Daren Garratt
Executive Director
The Alliance
(www.m-alliance.org.uk)
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The
Pharmaceutical Journal