Métaphore Volume 3 - RAPDOQ

LA MÉTHADONE / METHADONE
10
So the question is now being asked – are these risks
an adequate reason to deny solid methadone to all patients
within methadone programs? Does the fact that a
few people will misuse it justify a decision to deny it to
everyone? In the last couple of years, pressure on this
issue has steadily increased. Some patients feel they
can make a good case for accessing solid methadone,
and awareness is growing that this is possible for some
patients within Canada, and many more outside this
country.
In a 2003 survey of patients at a large community clinic
in North London, England, (2), the number of patients
receiving methadone in tablet form was 17.2 %. A 1997
survey of more than 40,000 prescriptions across the
UK (3) found that 9% of them were for methadone in
tablet form. In the North London study, patients receiving
methadone tablets had a lower proportion of urines
positive for illicit opiates than those receiving traditional
liquid methadone.
This reflected the stability of those patients being prescribed
tablets. Not surprisingly, the clinical criteria for
getting tablets was very specific. The patients had to
have stopped injecting drug use for some years (usually
three), had no positive urines for illicit drugs, and had to
have good reason for needing tablets – such as going
on holiday abroad or travelling as part of their work.
There are many methadone patients who no longer inject,
who work, and who are well integrated into ‘normal’
life here in Canada. In clinical terms, they are “high
functioning” individuals. But not enough is known about
this group of people in Canada as few studies appear to
have focussed on such ‘quality of life’ issues, especially
for patients who have stopped using illicit drugs. They
have no voice in policy development as they have never
been invited to sit on the College regulating committees.
Stimulating debate by writing letters or speaking in public
or to the media can mean public identification as a
methadone patient, which can cause problems and lead
to discrimination in their life.
But this is slowly starting to change. Organisations like
the National Opiate Treatment Association of Canada
are being formed to advocate for such changes and help
to move them forward into reality. The new Canadian
Drug Treatment Strategy, to be launched later this year,
gives a high priority to the involvement of patients themselves
on policy making bodies.
At the heart of the problem is the misperception that all
methadone patients are still injecting drug users, don’t
have legitimate jobs that involve travel and working
away from home, and can’t be together enough to afford
a holiday or travel to visit their family.
In reality, there is a enormous variation in the life circumstances
of Canadian methadone patients. Methadone
treatment is now accepted as a legitimate strategy for
the management of chronic opiate dependency but the
structures and protocols for its management have not
yet caught up. We need to recognise the importance of
individualising care for all methadone patients and enshrine
this principle within our treatment protocols. We
should want every person in methadone treatment to aspire
to a life of quality and achievement, and many will if
they are given the chance to do so.
1. Methadose ® 40 mg Dispersible tablet http://pharmaceuticals.
mallinckrodt.com/Products/Product.asp?UT=0&BusinessUnitID=4&Pr
oductID=5379
2. A survey of methadone prescribing at an inner-city drug service
and a comparison with national data. Psychiatric Bulletin (2003) 27:
167-170.
3. Effect of government recommendations on methadone prescribing
in south east England: comparison of 1995 and 1997 surveys.
BMJ (1998) 317:1489-1490 ( 28 November )