Methadone matters etc

[johnep]

Nearby PCT has been vastly overspent. However, this does not prevent them offering addicts a large 'pick and mix' selection of various brands of syringes, needles, swabs, citric, and WFI. Latest is a one use sterile metal cup(Orion Med Prods) with a filter to ease the preparation of a dose. All the films show a teaspoon being used, but presumably this may have been used to stir someones tea so not approved of by the harm reduction unit. This is all very laudable, but surely money spent here means less elsewhere.

In the meantime, a whole industry has grown up and several people depend on addiction services for jobs.
johnep

[Pharmanaut]

Re: Methadone matters etc

Nearby PCT has been vastly overspent. However, this does not prevent them offering addicts a large 'pick and mix' selection of various brands of syringes, needles, swabs, citric, and WFI. Latest is a one use sterile metal cup(Orion Med Prods) with a filter to ease the preparation of a dose. All the films show a teaspoon being used, but presumably this may have been used to stir someones tea so not approved of by the harm reduction unit. This is all very laudable, but surely money spent here means less elsewhere.

In the meantime, a whole industry has grown up and several people depend on addiction services for jobs.
johnep

Amazing - have we lost our minds.
All goes well until someone sues the PCT for suffering harm while using equipment provided by them?
More work for the 'no win - no fee' compensation culture.

[Jeff]

Re: Methadone matters etc

Latest is a one use sterile metal cup(Orion Med Prods) with a filter to ease the preparation of a dose. All the films show a teaspoon being used, but presumably this may have been used to stir someones tea so

The idea is to avoid sharing

Jeff

[Rafael]

Re: Methadone matters etc

are we supposed to provide needle exchange service for methadone patients?
i think its a horrible idea to give a methadone patient needles!!!
i noticed some comes in morning for methadone dose, then at afternoon for needle exchange" to collect them from a different staff member".

what do you think?

[johnep]

Re: Methadone matters etc

Very frequent in some pharmacies. I would phone drug team and let them know, but usually at weekends. Also not sure re pt confidentiality and the thought police.

One chap who eventually got three years for dealing under cover of selling 'Big Issue', used to ask for several packs of 1ml 'for my friends who wont come in'.

Gues he was able to offer his customers the full package of the drug plus means of administration. He was not on methadone so no drug team to inform.

Now out and about after only a year and selling 'big issue' again. saw him yesterday in the market.

Just had a blurb from PCT re the C card for issue of condoms. Apparently now considering issuing flavoured and ribbed varieties, also free pregnancy tests.

Just what is England coming to?
johnep

johnep

[Ijenks]

Re: Methadone matters etc

Our LHB (PCT) actually pays for our "Clients" to travel to and from the Pharmacy in a taxi! Yet the very same LHB will not pay for elderly patients to travel to the local hospital. Something is very, very wrong indeed.

Nearby PCT has been vastly overspent. However, this does not prevent them offering addicts a large 'pick and mix' selection of various brands of syringes, needles, swabs, citric, and WFI. Latest is a one use sterile metal cup(Orion Med Prods) with a filter to ease the preparation of a dose. All the films show a teaspoon being used, but presumably this may have been used to stir someones tea so not approved of by the harm reduction unit. This is all very laudable, but surely money spent here means less elsewhere.

In the meantime, a whole industry has grown up and several people depend on addiction services for jobs.
johnep

[Web Ferret]

Re: Methadone matters etc

Some of the clients at one place I frequent went on an outing to Flamingo Land (a theme park) yesterday. I assume that my (and your) taxes are paying for this.
Its quite regular for methadone clients to use the exchange (not that there is much exchange...). I queried this with the prescriber - The focus is now on "harm reduction" rather than getting off it, getting a job etc...

[Jeff]

Re: Methadone matters etc

are we supposed to provide needle exchange service for methadone patients?

Yes

i think its a horrible idea to give a methadone patient needles!!!

Why? Do you think it would be better if they shared someone else's needles?
Abstinence from illegal drugs is a goal to work towards - that doesn't mean that it's always achievable nor that it is expected from day 1 of treatment

i noticed some comes in morning for methadone dose, then at afternoon for needle exchange" to collect them from a different staff member".

Be up front - if the needle exchange is confidential - they might as well pick up needles when they pick up their methadone. If it isn't fully confidential tell them that their key worker will be informed whatever time they pick up their needles.

what do you think?

That it's a team approach and you play by the rules of the team you're in - you can't just make up your own rules as you go along.

Jeff

[Rafael]

Re: Methadone matters etc

alright, no problem. i just assumed its illegal to give methadone patients needles. thanks for clarifying things. even that i know a lot of them will be using the needle to inject drug, but as far as its legal and the government cares only about them not sharing the needles and contamination, then i simply do not mind to give Mr addicts some needles

[Web Ferret]

Re: Methadone matters etc

I think selling needles is still a grey area but a needle exchange under local guidelines is OK.

Regardless of our own beliefs we still have to be professional and do whatever is required of us. There are lots of things I don't agree with but you would never guess it if you saw me working.

Be professional and have a good rant on here

[Fleegle]

Re: Methadone matters etc

I was involved in the introduction of the supply of methadone to registered addicts in Scotland in the 1980's. Unfortunately, the decision to supply coincided with the government's move to scare everyone out of their wits with poster campaigns such as "AIDS - DON'T DIE OF IGNORANCE!"

It went downhill from the start...

Here are a few of my own observations, based on my experiences..

1) I have only ONCE seen a reducing daily methadone dose be successful..the girl was pregnant, and managed to reduce to zero. One week after the birth, she was back on 60ml.

2) Needle exchange..counter staff were not insured in any way against possible needle pricks, or blood spatter, but they carried on regardless. For "needle exchange", read "needle demand" We may think we're doing the correct thing by supplying clean works to the addict, but where do the used needles end up? Quite possibly discarded, and in the hands of a 2-year-old who picked it out of the gutter. Who should we be protecting?

3) An addict once threatened to "chop me up". Are you looking forward to fighting your way through the queue of addicts outside the shop tomorrow?

4) Most methadone is sold on. It has been proved that addicts have a "drug of choice" (usually heroin). The methadone programme merely gives the addict a saleable product, in order that they may buy more heroin.

5) In doing this, when heroin addicts sell their methadone on, they generally do so to the kids in the area..so creating METHADONE addicts, as it becomes THEIR drug of choice. (They can't afford heroin), so creating a market for their daily dose.

6) "Spit/Vomit Methadone". You may "supervise" the dose, and give a drink of water afterwards, but what you might not know is that very often it is still held in the mouth on leaving the shop, or regurgitated afterwards, and sold on.

7) Possibly the worst..In the Stirling area in 1989 some GPs were prescribing ampoules of diamorphine, complete with hypodermic needles to their addicts. I have never yet found out why...

There is more..reply to this if you are in any way concerned.

[Jeff]

Re: Methadone matters etc

I was involved in the introduction of the supply of methadone to registered addicts in Scotland in the 1980's. Unfortunately, the decision to supply coincided with the government's move to scare everyone out of their wits with poster campaigns such as "AIDS - DON'T DIE OF IGNORANCE!"

And has an AIDS epidemic been avoided?

1) I have only ONCE seen a reducing daily methadone dose be successful

Methadone maintenance was for the most part the aim of treatment - abstention was not the goal.

..the girl was pregnant, and managed to reduce to zero. One week after the birth, she was back on 60ml.

I've a patient who entered treatment under similar circumstances and is now "Clean"

2) Needle exchange..counter staff were not insured in any way against possible needle pricks, or blood spatter, but they carried on regardless.

As employees they should be some cover for work related injuries.

For "needle exchange", read "needle demand" We may think we're doing the correct thing by supplying clean works to the addict, but where do the used needles end up? Quite possibly discarded, and in the hands of a 2-year-old who picked it out of the gutter. Who should we be protecting?

Depends on how the system is run and the requirement for returns.

3) An addict once threatened to "chop me up". Are you looking forward to fighting your way through the queue of addicts outside the shop tomorrow?

They know damn well that no-one is going to get anything until I get in - so there's no need to fight my way through. They very rarely cause any real trouble.

4) Most methadone is sold on. It has been proved that addicts have a "drug of choice" (usually heroin). The methadone programme merely gives the addict a saleable product, in order that they may buy more heroin.

Some methadone is undoubtedly sold on - that's part of the argument for supervision. As for the drug of choice - and heroin prescribing - that is now being piloted again. The switch from heroin to methadone prescribing was strongly influenced by the work of Hartnoll et al. (do a google search for Hartnoll Heroin) - it is at last being challenged.

5) In doing this, when heroin addicts sell their methadone on, they generally do so to the kids in the area..so creating METHADONE addicts, as it becomes THEIR drug of choice. (They can't afford heroin), so creating a market for their daily dose.

Again part of the case for supervision - and treatment with the drug of choice.

6) "Spit/Vomit Methadone". You may "supervise" the dose, and give a drink of water afterwards, but what you might not know is that very often it is still held in the mouth on leaving the shop, or regurgitated afterwards, and sold on.

Talking to the patients (a strange idea - I know) reduces the likelihood of the dose being held in the mouth - not sure what to do about regurgitation

7) Possibly the worst..In the Stirling area in 1989 some GPs were prescribing ampoules of diamorphine, complete with hypodermic needles to their addicts. I have never yet found out why...

You said it earlier - drug of choice.
revolution: liverpool clinic
Dr John Marks - did the publicity bit well, but unfortunately never published any robust research.

Jeff

[Fleegle]

Re: Methadone matters etc

OK Jeff..

Based on both our opinions, Do you think we are really addressing the addiction problem, or merely fuelling the fire?

[Jeff]

Re: Methadone matters etc

OK Jeff..

Based on both our opinions, Do you think we are really addressing the addiction problem, or merely fuelling the fire?

We've avoided an AIDS epidemic, I've seen chaotic lives resume normality, I don't think we are fuelling the fire - the growth in crack addiction happened without any pharmacy involvement.

I don't think we are addressing the problem of addiction, just dealing with it once it has become apparent.

Are we dealing with it the right way? Probably not.

We deal with addiction rather than patients - we have a works entrance and hand out the medicines through a hatch. Isolating them from the rest of the public.

Drug History Timeline - Lifeline Project
and click on 1905 at the bottom (orange) line. (I've no idea of why the video is found there - but there it is.)

Treatment is clinic based rather than GP based - again isolating them from the rest of society.

Success isn't measured in lives rebuilt but in numbers in treatment and money saved from uncommitted crimes.
Interview: Mary O'Hara meets Paul Hayes, head of the National Treatment Agency | Society | The Guardian

How would I want me and mine to be treated for addiction - not the current way.
Rehab/detox and a naltrexone implant - then lots of follow up.

Jeff

[Fleegle]

Re: Methadone matters etc

VERY interesting video. There was a similar setup in place in a "pill-box" pharmacy in Easterhouse, Glasgow in the mid-eighties. It wasn't nearly as professional, but the principal was exactly the same. Dispense through a letterbox to keep the Pharmacist safe.
I really still find it very difficult to accept that supplying any opiate-based narcotic to any addict is the way forward. They will still commit crime, albeit not in the pharmacy, and I do not think the role of the pharmacist, based on our training,is to simply dole out opiates at the request of the local GP, (who is threatened with violence as often as we are..without the hatch). Think about that one.
My opinion will not change. We were not prepared for this..it is not our job.
As a postscript, I have just attended the graduation of my daughter. She has not become a pharmacist, and I am delighted.