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Putting methadone into perspective - responses

May 18 2009
A substance misuse practitioner disagrees with Andy Zapletal about on-top alcohol use practices Last month's 'Cold turkey' article was quite interesting, but there were a couple of inaccuracies. First, it is not strictly true that those who use illicit drugs on top of their prescribed drugs will be taken off their methadone treatment. Historically that may have been the case, but it certainly shouldn't be so now. Yes, the treatment provider may suggest an increase in the amount of methadone prescribed, but if the service user refuses this increase, they shouldn't be taken off their script, at least according to current good practice guidelines. However, the most worrying inaccuracy was to do with the inference that agencies would not look at a service users' on-top alcohol use. This is one of the biggest causes of concern with regards to overdose risk, and most agencies that I have worked with will breathalise service users if they believe this risk exists. Jane Askey Substance Misuse Practitioner Andy Zapletal replies: My editor said: "it's a reasonable letter. Will you write a reasonable response?" If you're trying to convince me what a good job you're all doing in Methadone-Prescribingland, I remain unconvinced. You state: "it is not strictly true that those that use illicit drugs on top, will be taken off their methadone treatment." Well, it's not strictly true that they won't... You say: "it certainly shouldn't be so now." Why? What are the upper levels of "on-top using" and when is enough, enough? Your statement that "if the service user refuses this [methadone prescription] increase, they shouldn't be taken off their script," provokes the same response. The thousands of treatment providers interpret 'guidelines' differently. I'm not inferring that agencies do not look at service users' "on-top alcohol use". You may well look at on-top alcohol use, but looking too closely at alcohol-related issues across the sector is not an NTA (National Treatment Agency) imperative. Getting clients onto legal drugs, be it alcohol or methadone, looks better on stats, but as one client pointed out, "If I'm face down in the gutter, does it make any difference whether or not the drugs are legal or illegal?" On-top alcohol use "is one of the biggest concerns?î??? and most agencies [will] breathalise service users if they believe this risk exists". That's good to hear, but it's a judgement call again. Are clients not getting past this ad hoc screening system? Are you saying that clients (with a high tolerance to alcohol) can't have couple of cans of nine per cent alcohol before morning pick up and seem pretty together? They do, and they also use a range of licit and illicit substances throughout the day. And finally, do clients get tested when they go to the chemist? Again, well no, not really. As long as they seem together, they will get their prescription dispensed. The current system of methadone prescribing still varies from borough to borough, is expensive and, in my opinion, not very effective. I go by what I said in my article: methadone and alcohol use keep clients in "the treatment loop". Good for us, in the industry, but not for them.