Methadone

[laura/nottingham]

Am I right in believing that technicians have to do a course to supervise methadone and subutex??

[jaymags]

I've not heard that one Laura, the techs, including me, do supervise methadone and subutex where I work. Maybe if it's the case that we should have to do a course then I should be pointing that out ot my boss.
Most of the addicts we see are more polite than some of the regular customers but have a tendancy to moan about the pharmacist rather than have a go at the rest of the staff.
The only problem is some tend to come in groups and hang about outside the shop whilst waiting their turn which can be of putting to the regulars.

[johnep]

Every town has it's 'methadone club' where they all meet to gossip, smoke, drink special brew, and score.

Many addicts live together and what with the companionship, welfare benefits, ie disability of addiction bringing in extra money, little incentive to get off methadone.

johnep

[Sandman]

I had a script on friday (15/9) for methadone, 36ml daily, dispense 252ml on 14/9 for a patient I know fairly well. What to do? Could I find the appropriate section in the MEP? No. So I phoned my former pre-reg tutor, who said that he had reduced the amount accordingly plenty of times in the past, so that was what I did (he also happens to be the professional services manager for the group I work for). I've now found the section in the MEP where it says about CD scripts being dispensed only in accordance with the prescribers directions (so I take this to read that I shouldn't have dispensed it).

What would others have done?

In my local Health Board the prescribers endorse all methadone prescriptions with the start date and the simple abbreviations 'APC' and 'DLDM' - 'Allow for Pharmacy Closure', and 'Dispense Less Days Missed' respectively.

These are legally acceptable endorsements and covers the pharmacy to dispense accordingly for 1) Any period of shop closure be it Sundays, bank Holiday weekends or Christmas/New Year closures (obviously if the store is open 7 days then a 'Sunday on Saturday' direction is still necessary as there is no 'closure'), and 2) Any missed days can be taken out of (for example weekly collect) prescriptions without any need to contact prescriber, amend script etc. 'DLDM' also puts you "in the right" in the client's eyes, on the odd occasion where the methadone client gets ratty at the fact you are taking days off them.

I don't know why other Health Boards don't use these abbreviations - it takes an extra two seconds to add to the script and saves everyone a hell of a lot of hassle.

[Jeff]

Am I right in believing that technicians have to do a course to supervise methadone and subutex??

Depends on the PCO and their requirements for making payment.

Jeff

[lamzee]

In my local Health Board the prescribers endorse all methadone prescriptions with the start date and the simple abbreviations 'APC' and 'DLDM' - 'Allow for Pharmacy Closure', and 'Dispense Less Days Missed' respectively.

I don't know why other Health Boards don't use these abbreviations - it takes an extra two seconds to add to the script and saves everyone a hell of a lot of hassle.

How are these simple abbreviations? If I was working somewhere and saw a script with APC or DLDM on it, I wouldn't have a clue what it meant ! Full wording might be better.

[flukee]

I would just like to say a few things as a methadone user. In reply to the first post, all addicts are not like that. If you are inherently bad then you will be worse on drugs but just as in straight society there are good and bad. I am a functioning addict of 20 years. Heroin was my drug of choice until I sought treatment. I was then prescribed methadone which I have been on for around 7 years now. I am a complete advocate of the non-prescribing of methadone. It does not deal with the problems that lead to addiction (although no medication does) but reinforces the addiction along with enabling the user to continue to use at the risk of OD. I concede methadone allows a users life to be more stable but only to a point. Methadone has a huge stigma attached to it and unlike any other medication for any other illness people assume you are completely dysfunctional, labelling you as part of the methadone club, tenants super drinking, thieving layabout smack head stereotype. Whereas a huge number of addicts are working people criminalised purely by their addiction. However back to methadone. There are two types of people who seek treatment, those who really want to abstain from illicit drug use and ultimately all drug use, and those who just want to be a bit more stable. Methadone is a bad option for both of these. For the abstinence route methadone is extremely hard to detox from and if stopped suddenly, even from a low dose such as 20 mg, can cause convulsions and severe discomfort far far worse and much more prolonged than heroin. I have experienced this personally. For the stable route methadone does not offer the high most addicts are looking for causing them to use on top of their script risking overdose and then questions being asked of the prescribing authority as to why this happened. Having gone through the system time and time again I believe that for those really seeking abstinence or even maintenance without the high subutex should be used. Those wishing for stability and to reduce criminal activity or just not be criminalised by their disease should be prescribed morphine or diamorphine. This is a far more effective way of allowing an addict to bring their life back into control. Now I know there are people who manage methadone maintenance, and methadone detox, but the vast majority do not and will bounce in and out of treatment for the rest of their lives. I myself have almost been off of methadone so many times, then the withdrawal just got too much and went on for so long with no letup that I have used illicit drugs for a quick relief from my symptoms. This just reinforced the power of my addiction. All treatment options need to be considered to suit the clients needs and must be given with the appropriate psychological support otherwise you may as well just not bother, as treating the symptoms doesn’t help the disease. This i have discovered from being prescribed by a treatment centre that offers nothing but a prescribing facility. I hope my experience gives you some insight into the real effect of methadone. One last thing i wish to add is it is important for anyone using methadone to realise the increased risk of overose. Methadone at higher doses does block the effects of heroin, to this end the user in search of the high stands an extremely high chance of overdosing and on that point i do not avocate the use of other opiates with methadone. But if you are going to use smoking is a much safer way as opposed to injecting. Also for anyone considering using methadone without medical supervision please be aware that unlike short acting opiates methadone stability is achieved through a build up of the methadone in your body, this means overdose is more likely to happen on day 3 -4 once the mthadone levels have peaked. personally i would never use illicit methadone as people water it down to achieve more profit, this could mean a dose that has little effect can put you over if you then recieve unadulterated methadone. Also be aware there are many mixture choices such as 1mg/1ml which is the usaual. However when taking higher doses the client can be prescribed stronger solutions, such as 10mg/1ml making the chance of overdose 10 fold should you be unaware of what you are taking.

[Jeff]

Flukee,
I've read your exchange with Tony, and also wanted to say well done for what you have achieved so far.

As for sharing your experiences of methadone could I suggest that you consider sharing them on Wiredin - and that the rest of us also have a read.

Empowering people to tackle drug and alcohol use problems - Wired In (Wired Initiative)

Take care

[flukee]

Jeff

Thank you and will be more than happy to.

Flukee

[howe928]

How are these simple abbreviations? If I was working somewhere and saw a script with APC or DLDM on it, I wouldn't have a clue what it meant ! Full wording might be better.

ya, no guessing please

Am I right in believing that technicians have to do a course to supervise methadone and subutex??

it depends what standard operating procedure says
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Have you used any Methadone Dispensing Machine yet? Any problems?