Experts back methadone treatment
Thursday 22nd August 2013, 2:10PM BST.
Methadone is an effective drug treatment and should continue to be used to treat heroin addicts, government-appointed drugs experts have advised.
The Scottish Drugs Strategy Delivery Commission concluded that opioid replacement therapy (ORT), particularly methadone, is supported by strong evidence and is being dispensed in accordance with national guidance.
The Commission’s report calls for urgent improvements in drug research amid rising deaths and stigma attached to ORT fuelled by ignorance, cautious politics and media scaremongering.
Drug misuse costs Scotland’s economy £3.5 billion but the public sector spends a hundredth of that (£36 million) on drug services, the report found.
The group, chaired by addictions expert Dr Brian Kidd and commissioned by Chief Medical Officer Dr Harry Burns, also calls for action on social inequality, with methadone users found almost exclusively in deprived areas.
However, it questions the public sector’s appetite for action in the current financial climate and the Scottish Government’s ability to tackle inequality “without a higher degree of economic control or closer collaboration with the UK Government”.
The Commission also said some newspapers reported on methadone in an “extremely negative” manner while critics claimed community pharmacists achieved “excessive profits” from the delivery of the treatment.
The report found scepticism and some “overt hostility” to methadone from users and their families.
One user told researchers: “It seems to be killing a lot of people at the moment. When the cure kills more people than the problem then that’s difficult.”
Other users were more positive, stating: “It saved my life. I stopped injecting, stopped using drugs. Got to know my family again.”
Dr Kidd said: “The perceived failure by some of the current Scottish strategy, the Road to Recovery, has been fuelled by drug death statistics which had revealed a continuing increase in fatalities. The medical treatment, ORT using the drug methadone, had become the focus of concern.”
Drug research has been “poorly developed despite the magnitude and seriousness of its manifestations”, the report said.
It added: “Ring-fenced resources for substance misuse services in Scotland currently consume some £36 million per annum.
“If the additional costs incurred by social care, child protection, criminal justice and generic NHS services were taken into account, the cost to the Scottish tax payer is more realistically estimated to be in the region of £3.5 billion.
“This high cost problem – in terms of monetary and societal costs – should be a national research priority for Scotland. Failure to address this is a false economy.”
The report continues: “Users of ORT services come almost exclusively from areas of multiple deprivation.
“Many efforts have been made to lessen the impact of income inequalities in Scotland but, to date, these have been only partially successful
“Under the current national governance arrangements and the financial pressures experienced in the public sector at this point, there seems some doubt as to first, to what degree there is an appetite to confront and second, just how much the Scottish Government can realistically do without a higher degree of economic control or closer collaboration with the UK Government.”
Dr Kidd likens the current debate over ORT to the investigation into the Challenger space shuttle disaster in 1986, where public relations risked taking precedence over reality in the search for answers.
The United Kingdom Drug Policy Commission (UKDPC) found that drugs policy “is currently a mix of cautious politics and limited evidence and analysis”.
Dr Kidd’s Commission states: “A survey of some MSPs by the independent UKDPC had reported that a majority of respondents had stated that they felt the current strategic approach was failing to deliver the expected improvement.
“Media reporting in some Scottish newspapers focused on the place of the drug methadone, with articles reporting in an extremely negative manner and challenging the prominence of ORT in general and methadone in particular.
“An analysis of a sample of newspapers suggested that reporting was sensationalised, being dominated by crime reports and celebrity with much use made of pejorative adjectives such as ‘vile’. The media rarely dealt with the complexities of treatment and recovery.”
MSPs have also raised concerns about “the way methadone dispensing is funded – with some critics perceiving that this resulted in community pharmacists achieving excessive profits from the delivery of an essential service”.
The report states: “It is recommended that steps are taken to investigate the complexities of the current pricing structures and to explore if any potential alternative new mechanisms could be developed to further reduce drug costs.”
Dr Burns said: “Opioid replacement therapies, including methadone, have had a beneficial effect in preventing the spread of viruses among drug users. However, they often simply switch one form of drug use for another, albeit a safer one.
“That’s why we need to find more ways of helping people access a range of treatments and support, tailored to their needs and their aspirations for sustained recovery.”
Community safety minister Roseanna Cunningham said: “This report underlines the importance of methadone treatment but also makes clear the need to improve access to other treatments and support.”
She pledged to hold planning meetings with drug workers and political parties with a view to providing a response to the report in November.
David Liddell, director of addictions charity Scottish Drugs Forum, said: “It is entirely right that the review sets problem drug use and treatment in the social context of the hugely significant income and health inequalities which prevail in Scotland and which underpin so much of Scotland’s drug problem.
“We also welcome the review’s recognition of the extensive and long-standing evidence base for opiate-replacement therapy as an effective treatment for problem opiate use.”
He called for “a more informed level of discussion about tackling problem drug use”.
Labour deputy justice spokeswoman Elaine Murray said: “Methadone is undoubtedly a vital component in helping people tackle drug addiction but this report identifies serious problems which the Scottish Government need to address immediately.
“There is a role for methadone and where addicts are stabilised and getting monthly review and prescriptions from the GP it can be very effective. However for chaotic addicts it becomes yet another drug used with heroin and alcohol. We need more than words and reports, we need action.”
Liberal Democrat leader Willie Rennie said: “Following the hysteria stirred up on the link between methadone treatment and drug deaths, this is an evidence-based report that should reassure people that methadone is part of the solution to Scotland’s drug problem, not simply part of the problem itself.
“I am pleased that the report has made some sensible recommendations about improving practice.
“It is also welcome to see a piece of work that is so clearly focused on evidence, medicine and science, and not the moral judgements that have dominated discussions on drug treatment policy in the past.”
Conservative health spokesman Jackson Carlaw said: ” I’m in agreement with a number of the recommendations set out in this report.
“However, I’m extremely disappointed that abstinence is not mentioned in the key recommendations.
“That is an unambitious conclusion to reach and does nothing to ease fears we will simply continue parking people on alternatives with no hope of them getting their lives back on track.
“A tougher approach on this matter would help everyone, from addicts and their families to the victims of the crime many of them commit to fund their habit.
“Unfortunately, many regard the Scottish Government’s rhetoric on this issue as one of defeat, and that is not good enough.”
The report found that healthcare opinion was divided as to whether abstinence was the absolute goal for everyone.
It stated: “Some prescribing clinicians felt that due to the high level of relapse following becoming drug-free and the associated risks this brought, to detoxify anyone was to put them at increased risk of death.”
ORT treatment is also “inversely related” to the chances of achieving long-term abstinence, it said.
“ORT patients were less likely to die but also less likely to become abstinent.”