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Letters to the Editor
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Methadone dispensing
Payment should reflect daily doses
From Dr J. Keen
As GP clinical lead at a large primary care prescribing service for drug
users in Derby, I am concerned about the possible impact on safety of the
changes in the FP10MDA payment structure for pharmacies dispensing maintenance
methadone for drug users. If pharmacists are not paid in a way that reflects
the extra work involved to dispense in separate, daily-dose bottles, I
fear that large, undivided amounts of methadone are far more likely to
be dispensed.
I agree with the points made by your correspondents Martin
Bennett (PJ,
14 October, p449), Andrew
Moule (21 October, p482) and Richard
Wells (28
October, p514) and in particular with the point that, even under ideal
circumstances, many of us would have difficulty in measuring a viscous
fluid accurately over a period of days. Our patients are often not operating
under ideal circumstances.
We know that by far the major cause of death from opiates is respiratory
depression due to overdose. Supplying methadone in large, undivided quantities
is likely to predispose patients to overdose both by faulty measurement
and through heroin use when the supply runs out early. Many patients admit
to simply swigging from larger bottles and if a larger bottle is spilt,
harm reduction is at risk as the patient may lose several days’ supply.
In addition to this the risks to children must be increased if larger bottles
are left lying around half used and incorrectly closed, and poor compliance
with treatment is likely if patients’ blood levels fluctuate constantly
due to erratic doses.
The National Treatment Agency has prioritised reduction of drug-related
deaths. Methadone maintenance treatment is a potent reducer of heroin deaths
but it needs to be prescribed and dispensed with careful safeguards. Pharmacists
play a key role and payment needs to reflect this. It is shortsighted to
cut corners on payments for pharmacists to dispense methadone in separate
daily bottles.
Jenny Keen
Regional Lead Clinician
Royal College of General Practitioners Substance Misuse Unit |
The
Pharmaceutical Journal