Methadone balance...

[DavidS]

Here's an interesting error for you:
A friend of mine made up the methadones and gave them to a dispenser to check. The patient was to have 50ml supervised and 25ml to take home daily. This was on a Saturday, so did 50ml and 100ml (50ml for the Sunday, plus the take home doses for the Saturday and Sunday.

The assistant checked it and. as usual, popped Sunday's etc in the bag.

Patient arrives and didn't really look at the bottle (last time will make that mistake), just handed it to the patient who necked it, then said "that seemed more than usual."
The contents of the take home bag were then checked and found to be 50ml.

The dispenser completely blanked when some kind of investigation was made, saying that what they did was correct.

Patient was fine about it: suggested that they might not take any further dose that day, and went to A and E if they felt at all unusual. As it was the patient's habit to get completely off his head on Saturday evening had no idea what unusual would feel like, but it seemed sensible advice. (The take home dose was "topped up" to 100ml).

Patient turned up as usual on the Monday morning having had no ill effects whatever.

All details have been disguised to protect the innocent, and it was a longish time ago.

[Fleegle]

Advise your friend to give up his career in pharmacy, and buy a pub, where his patrons will greatly appreciate their (legal) overdoses, at his (legal) expense.

[johnep]

Basic cause of problem here was lumping in the Saturday take home dose and the two Sunday doses together in 100ml bottle. Where a dose is split, then so should the other doses. Our local PCT and agency request individual doses at weekends. Only ones who get a bulk bottle are those on weekly pick up.
I would class this as poor clinical governance.
johnep

[Fleegle]

Ok..Joking apart..what is the 50ml supervised, and 25ml to take home daily about? should it be 25ml bd? Unusually rapid dose reduction?..never seen it reduced that quickly before.

[Tony Schofield]

Split dosing is not common but does happen. Sometimes when the methadone is also being used to control pain (I have a patient with disc problems who splits doses) it is appropriate. It is also done when patient request hypnotics. Splitting the dose sometimes does help them sleep at night more effectively. Also with very big doses patients sometimes vomit after say 200ml so splitting the dose may well be appropriate then

[johnep]

Quite routine in many pharmacies. Total dose daily is 90ml, 50ml supervised and 40ml TTA.
johnep

[DavidS]

Where a dose is split, then so should the other doses. Our local PCT and agency request individual doses at weekends. Only ones who get a bulk bottle are those on weekly pick up.
I would class this as poor clinical governance.
johnep

Well, I see your point, but I personally resist spending my employers' cash, when the prescribers resist asking for individual daily doses to be supplied, as is their right to do. But this is pretty rare, so I dare say will change the practice in the future, as well as checking more thoroughly.

More practically, as a locum, I fit in with the current practice at wherever I happen to be working (as long as that doesn't include overdosing too frequently ).

As far as Fleegle is concerned, thanks but no thanks. Pubs started the 100 hours opening some time ago and a large number are wishing they were pharmacists, poor fools.

[Fleegle]

As far as Fleegle is concerned, thanks but no thanks. Pubs started the 100 hours opening some time ago and a large number are wishing they were pharmacists, poor fools.

Point taken and accepted David, Happy New Year!

Fleeg.

[Jeff]

Split dosing is not common but does happen.

Depends on the area. One local DAT likes to start all patients on split dosing.

Also some patients are apparently "fast metabolisers" - (cue for someone to provide evidence for or against)

Jeff