Scottish methadone policy 'should continue', says review

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

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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