Scottish methadone policy 'should continue', says review

Patient drinking methadone Many addicts complain of being "parked" on heroin for years

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Methadone should continue to be used to treat heroin addicts in Scotland, a review commissioned by the Scottish government has concluded.

The Scottish Drugs Strategy Delivery Commission also said the system used to reimburse pharmacists for dispensing methadone should be reviewed.

Methadone has been at the heart of drug treatment strategies since the 1980s.

But its use had been widely criticised by recovering addicts and drugs workers.

The independent commission was set up in the wake of concern over the role of methadone in drug-related deaths. Almost half of those who died had been using the heroin substitute.

Methadone is by far the most widely used of the opioid replacement therapies (ORT), with more than 20,000 patients receiving it last year, but some users take it for years without being weaned off it altogether.

There are alternatives, including prescribing medical heroin, but many in the drugs field say the debate should move away from these to an examination of how the wider needs of drug users can be met.

The commission emphasised that while methadone as a treatment should continue, it should be used alongside other options to treat drug addicts including community and residential rehabilitation.

Some of its other recommendations included:

  • giving consideration on how to better address the link between health inequalities and problem substance use
  • improving local information systems in order to identify people on ORT and demonstrate their progress towards recovery
  • a national specification for pharmacy services for drug users should be developed to ensure high quality provision
  • discussing how substance misuse treatment can best be provided through GPs and community pharmacists, with action to reduce variations in practice

Dr Brian Kidd, who was asked by Scotland's Chief Medical Officer Dr Harry Burns to look at the issue of ORT, said: "We have concluded that ORT with methadone is an effective treatment and must remain a significant element of the treatment options available for those struggling with opiate dependency in Scotland.

"However, ORT must be one of a comprehensive range of treatment options in every area. It must be delivered to the highest quality standards and services delivering treatment must become more aspirational regarding the possibility of recovery.

"I hope our findings will provide the basis on which the Scottish government and local care providers can work to improve drug treatment and enable more people to go on to lead a life free of drug-related problems."


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  • rate this

    Comment number 78.

    Recreational drugs have only been criminalised for the last 100 years or so and this has not stopped people taking them. Drug companies make trillions out of drug addiction with drugs such as tranquilisers which ruin people's lives and methadone of course.

    What is the moral difference between the CEO of a major pharmaceutical company and the archetypal drug baron? THought so, nothing at all.

  • rate this

    Comment number 77.

    Depends what you judge success by - reducing crime or enabling drug users to become productive members of society. Methadone use will do the former but rarely the latter.


    I've never known anyone to use Methadone tablets for migraines, opiates are relatively ineffective, don't believe everything you read on the internet.

  • rate this

    Comment number 76.

    @ 67.Nomad

    "I'm on it, not for a drug related issue either but migraine control - in pill form not liquid."

    Only on HYS could a statement of fact like this get marked down. Just astonishing...

  • rate this

    Comment number 75.

    Those with entrenched, long-term habits will probably use both heroin and cocaine. They may take a methadone prescription and inject heroin twice a week as well as smoking crack. Or they might take a methadone prescription and inject heroin and crack together, twice a week. They may also take valium in tablet form.
    Layer upon layer of drug use.

  • rate this

    Comment number 74.

    Say what you like about methodone failing to address the core addiction.....

    .....but the truth still remains that addicts on Methodone programmes commit many less burglaries & muggings than do addicts just using smack.....

  • rate this

    Comment number 73.

    What a short-term view.
    Basically if none of these programmes were in place then the junkies would have to steal more stuff to fund their habits. Also a lot more of them would be in jail as a result.
    So, I hear jail is a really cheap option these days (sarcasm).

  • rate this

    Comment number 72.

    Another issue is the large number of users who also have underlying mental health problems.
    The drug use masks the mental health issue and neither issue is fully dealt with until both are dealt with.
    Unfortunately there appears to be no joined up inter-agency approach.

  • rate this

    Comment number 71.

    Did they get a payment for this from the manufacturer of methadone?

    seriously this isn't how to treat drug addicts.

  • rate this

    Comment number 70.

    Those on high doses of methadone who binge on benzodiazepam are at a high risk of overdose.
    The trouble is that the only contact these people have with health professionals is when they line up to collect their prescription at the chemist.
    The trouble is that there seems to be no political will to bring them into the fold and provide complete treatment within the NHS.

  • rate this

    Comment number 69.

    Needs monitoring as many addicts use methadone as a top up, more needs to be done to get addicts clean, its a miserable life, and impacts on families in the same way alcoholism does. Abstinence from all drugs, including alcohol, is the best option for addicts.

  • Comment number 68.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 67.

    I wonder how many of the posters on here have ever seen methadone, yet alone tried it or know somebody on it?

    I'm on it, not for a drug related issue either but migraine control - in pill form not liquid.

  • Comment number 66.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 65.

    Drugs policy are a joke; they do not actually address the addiction; keeps addicts coming back for more; what incentive is there for them to consider quitting; policies are there to promote profits for big pharma; most politicians have shares in big pharma, so why should they change this; as for the medical profession, they are not there to reduce the number of clients -they need pts to come back!

  • rate this

    Comment number 64.

    You can move the methadone users onto subutex and prevent heroin being taken on top - as long as the use is supervised

  • rate this

    Comment number 63.

    Why not prescribe heroin addicts, heroin? It would be clean, controlled, safer and cheaper. It would also under cut the dealers, who are causing addict to commit crime, to raise money, to feed their addiction.

  • rate this

    Comment number 62.

    33 Human - You don't know the difference between heroin & alcohol?

    You have lived a very sheltered lifestyle.

  • rate this

    Comment number 61.

    46.Oh Dear
    2 Hours ago

    I work in a pharmacy that has 150 regular methadone users per DAY! The cost of this per week is disgusting and in the end the tax payer end up paying for it! Plus they still use heroin on top most of the time so whats the point!

  • rate this

    Comment number 60.

    57. Oh Dear

    Yes, I agree, it is unfair.

    England is the only country in the UK paying for prescriptions.

    Free prescriptions lead to less serious medical treatments & hospital admissions & less admin costs, it makes economic & social sense.

    Btw If Labour/LibDems gain power again in Scotland, the Scots will be paying again just like England.

  • rate this

    Comment number 59.

    So basically if the Scots are giving out free methadone we should send all our heroine addicts up there.


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