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Limits to methadone prescription proposed by drugs agency

By Balzafire, Jul 19, 2010 | Updated: Aug 30, 2010 | | |
  1. Balzafire
    National Treatment Agency for Substance Misuse wants open-ended heroin substitute use ended
    Strict limits on how long drug addicts are allowed to stay on heroin substitute methadone have been proposed by the government body responsible for treatment strategy, in what will be seen as a watershed in UK drugs policy.

    The National Treatment Agency for Substance Misuse (NTA) is describing the move as a rebalancing of the system in favour of doing more to get addicts clean.

    But cynics will regard the shift by the NTA, which has faced criticism and calls for it to be scrapped, as a late attempt to save itself before the coalition review of arm's-length government bodies.

    Martin Barnes, the chief executive of the DrugScope charity, which represents 700 local drugs agencies, said: "A goal of avoiding open-ended prescribing through improved practice is not the same as, and should not be confused with, the setting of time limits."

    An estimated 330,000 people in England and Wales are addicted to heroin, crack cocaine or both. More than 200,000 are in contact with treatment agencies, but most are "maintained" on methadone or other synthetic opiates, at a cost of £300m a year, rather than pushed towards abstaining from all drugs, whether prescribed or illegal. Strict time limits on methadone treatment would require a big expansion of residential care for addicts.

    In a report last week the influential Centre for Social Justice, set up by former Conservative party leader Iain Duncan Smith, called for the NTA to be scrapped and replaced by an "addiction recovery board" covering drugs and alcohol misuse. The report repeated claims that only 4% of drug addicts are emerging clean from treatment.

    The NTA, which is responsible for England, disputes this figure, saying that the number of people "successfully completing treatment free of dependency" rose to 25,000 in 2008-09, about 12% of those who were in "effective" treatment.

    However, the agency has accepted that it needs to revise its approach in view of the change of government. In draft changes to its business plan, approved by the NTA board but not yet signed off by ministers, it states: "We intend to take forward the government's ambition for a rapid transformation of the treatment system to promote sustained recovery and get more people off illegal drugs for good."

    The aim, the draft says, is to rebalance the system and "ensure successful completion and rehabilitation is an achievable aspiration for the majority in treatment".

    The idea of time limits is drawn from new Department of Health clinical guidance for opiate prescription in prisons. The guidance requires that offenders serving sentences of six months or more should have any prescription reviewed at least every three months. The prison guidance states: "If there is some exceptional reason why abstinence cannot be considered, then the reason must be clearly documented on the clinical record at each three-month review."

    In the draft revision of its business plan, the NTA says: "No one should be 'parked' indefinitely on methadone or similar opiate substitutes without the opportunity to get off drugs. New clinical guidance has introduced strict time limits to end the practice of open-ended substitute prescribing in prisons. This principle will be extended into community settings.

    "New clinical protocols will focus practitioners and clients on abstinence as the desired outcome of treatment, and time limits in prescribing will prevent unplanned drift into long-term maintenance."

    The NTA declined to comment on its proposals. But word of its policy shift is prompting excited debate in the £1.2bn drugs treatment sector. The methadone issue became totemic for critics of the Labour government's social and criminal justice policies, and was raised repeatedly by David Cameron during the general election campaign.

    Karen Biggs, the chief executive of Phoenix Futures, a leading treatment provider, welcomed the move towards a "better balance" in the treatment system. "There are excellent examples across the country of recovery-orientated treatment systems that help people move from the most chronic addictions to a life of recovery," Biggs said. "A balanced treatment system which is ambitious for the individuals and communities with which it works will contribute to the wider social policy objectives of the coalition government."

    David Brindle guardian.co.uk, Sunday 18 July 2010


  1. missparkles
    I think this is a huge step backwards, cos this will put all addicts under pressure. The main thing on their mind is gonna be "I gotta get it right first time, cos my script is ending in****." No one can say how long it takes to get a broken life back together again, some people manage to use methadone for a relatively short time, cos they only have a few issues to deal with.

    Others who have a lifetime of dysfunctional living, and all the emotional and physical health problems that go with that, will need more time. They already have a stressful life to deal with. This cut off time will just add to those pressures, and could in effect, result in more relapses. And then an addict has to begin all over again. Costing more money.

    I also wonder who, and how it's gonna be decided, how long someone will get methadone treatment for? Will it depend on how long you've been addicted, or will there be a set time all addicts have to get well in? Crazy.

  2. VienneseWhyrl
    Methadone works. Stop the interfering
    Opioid substitutes are a key tool in the drug treatment box. Their use should not be restricted for political reasons

    The medical profession has reached a consensus. The front page of last week's BMJ reads "Drug users and HIV: Treat don't punish". Within its pages is a an analysis piece entitled "Why Russia must legalise methadone" and a report on the Vienna declaration, which calls for the incorporation of scientific evidence into drug policy.

    Meanwhile, the Lancet has a series of papers highlighting that while there have been large gains in fighting the HIV epidemic in the general population, the socially marginalised such as people who use drugs and who often enter prison systems, continue to be denied access to treatments, particularly opioid substitution therapy that both saves lives and prevents HIV transmission to others. The Lancet's editor, Dr Richard Horton, says: "Complacency about the HIV/Aids epidemic now would be a terrible mistake."

    The evidence for the benefit of treatments such as methadone is overwhelming. At a time when the UK should be leading the way in ensuring such benefits are available everywhere I am left wondering why the UK National Treatment Agency for Substance Abuse is instead pandering to politics by raising the possibility of returning to the outdated and discredited policy of time-limited methadone prescribing.

    As a doctor I use methadone and buprenorphine with many patients alongside a variety of psychosocial and other healthcare interventions. Prescribing can last for one week or it can last for 30 years – it is and should be completely patient-driven and dependent on them as individuals. An arbitrary time frame imposed on any patient's medication regime is unacceptable and I for one will not accept such political interference. It is essential that this new government's drug policy is based on sound evidence and we the clinicians must strongly resist a potentially lethal change to policy.

    Most sensible clinicians see abstinence as one end of a spectrum and see no conflict whatsoever with substitute prescribing. In my experience most people working in the field want the best for their patients. I am deeply offended by language such as "people indefinitely parked on methadone", "routinely writing off full potential" etc. If any of my patients wants to try and come off all drugs – they have my full support.

    Recently a group of doctors launched International Doctors for Healthy Drug Policies after becoming increasingly aware over the past few years of the wide divide between what we know works and the drug policy made by politicians and their appointees – most who have no background in practice and never meet nor work with people who use drugs.

    Reliable and persistent research shows that substitute prescribing treatment substantially reduces deaths, crime, HIV infection and drug use while also assisting social functioning such as improved education, training, parenting and employment. Methadone treatment has been endorsed by UN agencies: the United Nations Office on Drugs and Crime , the World Health Organisation and UNAIDS, as well as Nice and the Department of Health in the UK. The WHO has also included methadone treatment in its "essential medicines" list and 70 countries in the world now provide methadone or buprenorphine treatment to an estimated 1 million patients. It is up to us to ensure that this life-saving intervention is made available in countries such as Russia and the Ukraine where it could be saving literally millions of lives. Politicians in the UK must take up this global challenge instead of using people's fear of drugs and the use of false dawns in addressing these fears to gain a little extra popularity.

    Chris Ford
    guardian.co.uk, Monday 26 July 2010 10.00 BST

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