The management of drug misuse featured briefly in the leaders debates when David Cameron seemed to say that everyone should go into residential rehabilation, so it is no surprise that the Coalition seems to be trying to steer treatment policy.
The National Treatment Agency, a Special Health Authority giving advice on the management of illicit drug misuse, has new business plan that suggests that substitute treatment, usually with methadone or buprenorphine, should be time limited with patients “moved on” after a year or two. As ever, their choice of words is revealing – they talk of patients being “parked” on methadone. We don’t hear people complaining of diabetics being “parked” on metformin or insulin do we?
Up here in Scotland we have heard a lot of similar ill informed rhetoric for a long time now. “Research” has shown that if you ask heroin addicts if they wish to recover and not be addicted to any drugs they nearly all say yes. Who would have thought it? This leads some people to say that patients treated with substitute drugs cannot be said to have recovered even if they are doing well and free of illicit drugs.
This is dangerous nonsense. If I were to ask my diabetic patients if they wanted a complete recovery without the need to take medication I think they would all say yes. For many of the overweight maturity onset diabetics this would be perfectly possible with a change of lifestyle. Psychosocial measures, maybe even residential “fat-camp” ones, could all help them to get some weight off and excercise a bit. But should those who do not manage that be denied effective medical treatment? I don’t hear anyone saying that they should.
Of course we would all love it if we had a miracle cure for heroin addiction. But we do not. Residential rehabilitation centres are fabulously expensive and have a very low success rate. Even worse, the death rate is actually higher in the year following discharge since the few patients who have achieved abstinence lose their tolerance to opiates and are much more likely to die of overdose if they do go back to heroin or similar drugs. To encourage a treatment option that increases the death rate is irresponsible.
The World Health Organisation includes methadone in its list of essential medicines. Labour shoud speak up loudly in favour of evidence based treatment and not allow the Coalition’s confused ideology to risk the lives of thousands of patients.
Richard Watson is a GP in Glasgow, RCGP (Scotland) Clinical Lead Addiction
Tags: addiction, heroin, methadone, NHS, treatment
Bravo to Dr. Watson for this well written piece! Methadone treatment is recognized by a number of global organizations as the most effective treatment available today for opioid addiction. To limit time in treatment makes no more sense than to limit time in treatment for any other chronic disease, mental or physical. Yes, we’d all love to be completely free of the need to take medication, but for some, with chronic diseases, that just isn’t compatible with living a productive, normal life. This decision MUST be left to the patient and their physician, not to the government.
One thing that might improve the success rate of methadone treatment in the UK is a return to adequate dosing practices. The standard average dose required by most patients is 80-120 mgs. The average dose in the UK, however, used to be about 60mgs and is now about 30-40mgs–less than half the minimum dose required by most patients. This means that not only are the patients not on a blocking dose of methadone (i.e., a dose that would block the euphoric effects of other opiates, usually about 80mgs and above), but they go into withdrawals each evening as their dose wears off prematurely, and are often driven to seek relief from their symptoms by using street drugs. Adequate dosing would go a long way towards increasing retention rates and success rates in treatment.
‘Residential rehabilitation centres are fabulously expensive and have a very low success rate.’
Oh dear, more professional, uninformed and prejudicial nonsense from the NHS.
Our residential rehab in London is £485/week, and if you measure success rate as being those who finish the 12 week treatment, then we have a 95+% success rate.
Scotland loves its methadone, and with champions like Dr Watson and Kerry Wolf, the Scottish addicts will continue to get enormous amounts of the stuff for free. Ethicallly , doing the most good for patients is more important than doing the least harm…so anything to support, encourage and enable abstinence is more important than ‘parking’ patients on methadone. And yes, Dr Watson, they are’ parked’…and with no hope , no inspiration and no encouragement to kick the filthy second rate drug into touch, they will become ‘clamped’ as well.
Hello I’ve been on methadone for 20 yrs now although bought it from a source ie one of dr watsons patients I have never had heroin .but I did try it once and was smoking it not a needle user never have been or will be but have been on at one time 400 Mls prescribed and also been prescribed Valium /diazepam 35 Mgs daily for 17 years now I’m down to 160 Mls of methadone but have been told I will have problems coming off diazepam ?? And I won’t be prescribed yellow 5 mgs next year 2014 as government is curbing this as I do know a lot of people do abuse this privilege by selling either or both there drugs then will have to buy such things as heroin or STREET VALLIUM WHICH CAN BE ANYTHING FROM ASPRIN DIPPED IN INK TO WHATEVER THEY CAN GET DO .? This is playing Russian roulette with your life or health now I take 160 Mls of sickly sweet methadone then feel sick UNTILL it’s going through my body I can’t get the 10mls in 1ml as they have stopped that any ideas about the sickly sweet methadone as it bags me up most of the day is there any other thing I can do take to combat my sick feeling that I have to live with any suggestions welcome but methadone does let me lead a normal day apart from the sickly sweet dose everyday thanks to dr Watson I highly regard this doctor as he does take an interested view and is always up to date with what the government is doing . Keep up the good work dr r Watson ….