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Methadone - to dispense or not to dispense

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  • Methadone - to dispense or not to dispense

    Hi

    My pharmacy has just recently started dispensing methadone and although we’ve had no issues so far, I feel like I’m really struggling to identify if any of them have been misusing other drugs which means I shouldn’t be dispensing their dose to them.
    I’m aware of the signs to look out for i.e. constricted pupils, slurring of speech etc but several of them already have many of these simply due to the long term effects of drug use.
    A friend recently told me he would only refuse if they were “totally out of it and unable to speak or walk”. This signals to me that he would dispense it happily knowing that they may have been taking something - I’m not entirely happy with this as at the end of the day, the buck stops with me if something goes wrong.
    Can anyone give any advice?

    Thanks

  • #2
    Hi and welcome to the forum.

    I used to run an inner city needle exchange and also had a lot of methadone patients. The truth is most people on methadone do abuse other drugs as well. In fact I’d estimate from my experience that over 80% of them do. To be honest I’d say your friend has it mainly correct. Some people’s baseline is that they are always on some sort of drug. I would only refuse if I felt a person was very intoxicated, either from drugs or alcohol. The only thing that you really need to worry about is will that methadone dose send them into an overdose. The amount of medication and illegal drugs these people take is an awful lot compared to you or I. If you get to know them you will soon know their baseline and will easily spot if they have taken a lot more in any particular day. I have refused to supply and told them they could come back later in the day when they have sobered up.
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    • #3
      I was discussing this with a substance misuse prescriber the other day, and they had commented that anyone with a suspicion of using any other drug should be on Subutex instead of methadone. It was interesting to me because if that was the case, how often is that policy followed?

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      • #4
        Originally posted by Archer View Post
        I was discussing this with a substance misuse prescriber the other day, and they had commented that anyone with a suspicion of using any other drug should be on Subutex instead of methadone. It was interesting to me because if that was the case, how often is that policy followed?
        Take a look at the difference in price of treatment and you'll see why.

        In my experience the "good" ones are on Subutex as there is a much higher rate of full rehabilitation on buprenorphine. Everyone else who just wants maintenance is left on methadone long term as it works out cheaper.
        I remember when a blog was an individual boot.

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