Methadone Maintenance at Pharmacies

[USAddictionCounselor]

I am a drug addiction counselor at a opiate treatment center in the united states, I am also a recovering addict and methadone maintained. It is very suprising to me to learn from reading these boards that in the U.K. it appears methadone treatment is provided at the local pharmacy instead of a specialized clinic. I have read a lot of posts on here with a very negative view of methadone maintenance treatment and the patients who are in treatment. I wonder am I one of these "junkies" that people on these forums talk about?

I have seen lots of posts saying that these people are trading one addicition for another and that they should get off as soon as possible. It really scares me that this is the attitude of the people entrusted to provide this treatment. Maybe that is why in the unites states Methadone can only be deispensed (in an OTP setting) by a specially trained registered nurse. How challenging it must be for the recovering addict to have to deal with the mis information, and stereotypes from their tratment provider.

I feel a little education goes a long way.

1. Opiate dependance is a progressive, deadly, medical brain disease. It is not a lack of will power, or a lack of morals.

2. Methadone Maintenance treatment as pioneered by Dr's Nyswander, and Dole was designed to provide a means for people who are opioid dependant (because they have a brain deficency where they do not produce enough natural endorphins) a way to live productively in society without the craving and obsession for short acting opiates (morphine, oxycodone, heroin) The methadone provides a way for these people to finally feel normal. If you read the original JAMA article you will note that patients who only cared about thier next shot were suddenly interested in art, education, and employment. The goal has and was never to get on and off as quickly as possible.

3. Methadone treatment is not trading one addiction for another. Addiction is defined as the continuation of a behavior despite negative consequences, and also on absessive component such as the way an active addict will obsess on finding opiates. With a long acting opioid like Methadone there is not as an extreme peaking and troughing as with short acting opiates so there is no obsession. Also because the methadone is legally prescribed there are no negative consequences like with illicit substances.

4. The relapse rate on leaving MMT before at least two years is 80%. After two years in MMT it drops dramatically. There is no other known treatment for opiate addiction that works as well as MMT. It is a proven fact.

5. During the first few weeks of MMT it is expected that the patient will use. Until they reach the right dose the methadone may not hold them for a complete 24 hours. Also the presence of illicit opiates in a urine or swab should be treated as a sign they they may require a higher dose. not that they should be punished or kicked off treatment.

6. A person who is methadone maintained receives no analgesic effect from his daily dose. Because they have a high opiate tolerance they actually will require higher doses of short acting opiates in the case of injury/surgery than a non opioid maintained person. There is a higher risk of relapse from self medicating due to not treating someones pain than from prescribing a short acting opiate.

Sorry for any mispellings, I am not the best typer but I thought it was important to speak up here. Thank you for your time.

[johnep]

Presumably specialised clinics in the US have to be funded. We have clinics where pts seen and prescribed, but it is cheaper and easier to dispense the methadone from pharmacies. Also, clinics tend to work 9-5 and closed weekends etc. Pharmacies are usually open for far longer hours. I have dispensed daily doses on Sundays/Bank Holidays. Are the US clinics open at these times?
johnep

[radiohead]

Thank you for posting here and raising an intresting subject.
I am a locum pharmacist, and I do often get to see the provision of pharmaceutical services in variuos settings.
I have never worked in the US,and I dont think I could comment on MMT in your country, so with all due respect I think you cannot suggest that MMT works for every person, in every instance, in every setting, whether these individuals are deficient in certain neurotransmitters or not.
I have dispensed methadone to individuals who have been on it for 15 years. What is the goal? what are you trying to achieve with people who come into your shop and want thier dose of methadone as thier God given right and then the empty bottle is thrown back at you.
If you read other posts on this forum, you will realise that Pharmacists in the Uk, are disillusioned, full stop. MMT just happens to be part of that disillusionment.

[DavidS]

The brain is very plastic, and adapts its structure to usage and stimuli. To say that opiate addicts have different brain chemistry, usage and structure might be to confuse cause and effect. I believe there is some evidence to suggest that some individuals are more susceptible to becoming addicts, but actually I think we all have our addictions by your definition - not all chemical, though.

Also because the methadone is legally prescribed there are no negative consequences like with illicit substances.

That depends what you define as negative consequences, surely.

There is no other known treatment for opiate addiction that works as well as MMT. It is a proven fact.

well, I don't think this has been proven at all, for the reason that not all options have been trialled, by any means.

It has been proven helpful as compared with a telling off, for instance, but the research comparing methadone maintenance treatment with diamorphine maintenance treatment has never been done, for political reasons. Those of us in the UK who remember the outstanding success Dr Marks had in his clinic in Widnes using diamorphine are very sceptical about the claims made for methadone. For instance, the funding to that clinic was cut just before the research on treatment options was begun, in the UK. At the time, it was suspected that pressure from the US was responsible for this happening. It's all findable with Google. Here is a good article about it written at the time. http://www.boogieonline.com/revoluti...liverpool.html

If the research has now been done, please tell me and I would be pleased to have a look at it.

[drh785]

If you read other posts on this forum, you will realise that Pharmacists in the Uk, are disillusioned, full stop. MMT just happens to be part of that disillusionment.

I agree with this entirely!

[johnep]

Well, of course, US has no legal diamorphine so not much choice. What they do have, according to US pharmacy forums, is lots of 'Pain Clinics' cncentrated in Florida who seem to prescribe codeine and oxycodone with gay abandon.
johnep

[DavidS]

Er, I think gay might meen something different nowadays, Jon, even in Florida.

I didn't know diamorph was illegal to prescribe in the US. That would explain the pressure for us to drop it and adopt the US methadone model.

This all smacks a bit of the cannabis for MS relief saga, where of course everyone with MS knew that cannabis was the drug of choice for some, but the research couldn't be done. I've just edited my earlier post to include the link to an article written at the time, about the Widnes clinic. Here it is again http://www.boogieonline.com/revoluti...liverpool.html

[johnep]

Ah well gay and abuse of drugs often go together.
johnep

[USAddictionCounselor]

According to the AMA MMT has the highest success rate out of every currently licensed treatment available in the U.S.

The emerging research that I have been briefed on lately at workshops is beginning to show that the old theory of cause and effect (ie; i took opiates and that is what changed my brain chemistry) is not accurate from what I have been shown they are starting to find that a segment of the population is born with a chemical deficency that the opiates provide releif for. This would seem to explain why some people are injured and take opiates for pain and are fine and others become almost instantly addicted.

MMT in the United States is most often subsidized by state administered medicaid so therefore does not cost the average patient anything out of pocket. Typical clinics are open for dosing from 5 or 6 am to between 9 am or noon. In some very large cities they may be open for evening dosing as well. I think the added structure may account for some of the behavioral differnces in patients. (We still do have our patients that act out)

The goal of MMT is for the patient to live a productive, healthy life free from dangerous, or illegal behavior and free from illicit substances. I have seen many success stories and a lot of failures. Most often people fail in MMT because they want to "get off" in a year or six months of treatment and once they do they relapse. I have Doctors, Lawyers, Carpenters, Mechanics, Bankers, IT workers, etc... in treatment. People who have turned their lives around 100%

The reason I started this thread was not to disparage or attack the system in thwe U.K. but to provide a different point of view and some facts as I understand them. It hurts me personally and professionally to think of a person going for treatment and having the provider thinking of them as a "junkie" as I have read people say here. I recently had to let one of the parking lot attendants here go for calling a patient a junkie during an argument.

Please do not take my posting here as an attack on anyone, I genuinely just want to help people understand that they are providing an important LIFE SAVING treatment to people with a legitimate medical disease. That's all.

[johnep]

Not at all, we welcome experience from across the pond. My own (and others) opinion is that the general public could not care less about abusers. What they do care about is the associated crime. Perhaps we should have learnt from Prohibition. I think all drugs of abuse should be legalised and available on prescription. Hopefully:
1) Dealers will be removed.
2) Profits from drugs will not be used to fund war or other crime.
3) We can bring the troops home.
4) The glamour of illicit use will fade.

Perhaps we could draw on your own personal experience:
1) When you first felt you needed drugs, did you visit your Doctor or that Dealer down the street with a big shiny car.?
2) Did someone give you a freebie to get you hooked?

However, a whole industry with jobs has grown up around drugs, from youngsters wanting adventure with the US coast guard to the hosts of 'do gooders' and advisers dependent on drug users for their living. We have companies in the UK (Exchange Supplies) who produce the citric acid, packs of syringes, swabs, sterile cups etc. They would be most upset to lose their living.
johnep
johnep