Tighter controls urged on methadone 'takeaways'

Supplying drug addicts with "takeaway" doses of methadone is hazardous and should be reviewed, say researchers.

Dr David Reith and colleagues at the Dunedin Medical School found there were 92 deaths involving opium-type drugs in 2001-02 and 31 were related to methadone.

"A more robust monitoring of both the prescribing and dispensing of methadone could contribute to a decrease in methadone poisoning deaths," says their study in the latest NZ Medical Journal.

But they also note that access to methadone maintenance programmes appears to decrease the overall death rate related to opium-type drugs, so should continue, "with appropriate controls".

On these programmes patients dependent on illicit drugs such as heroin are switched to a daily dose of methadone, which is taken by mouth.

Auckland's Community Alcohol and Drug Services has about 1050 people on its methadone maintenance programme. More than half are allowed to take home at least one day's supply from their local pharmacy in addition to the dose they drink there.

Some are allowed four days' supply and a few even more than this.

Up to 400 of the programme's patients have jobs and live stable lives, said the programme's clinical team leader, David Gilmour, a social worker.

Scrapping takeaways and forcing everyone to go daily to their pharmacy would be a disaster because patients using takeaways relied on the flexibility they offered.
"You would probably throw 300 people out of work overnight because they wouldn't be able to get to work on time or travel for their work."

He said the benefits of takeaways hugely outweighed the risks. Patients' behaviour was monitored and their blood and urine checked to see if they were using illicit drugs or not taking their methadone.

"When we hear of people misusing we will test on suspicion. We also test everybody randomly at least twice a year.

"The vast majority of our people are fully compliant with the programme and are making really impressive changes."

While most of the methadone and morphine/heroin deaths in the study were considered unintentional, only a minority of the dextropropoxyphene, codeine and synthetic-codeine deaths were.

The researchers also urged restrictions on dextropropoxyphene, which is sold alone or blended with paracetamol and branded Paradex, Capadex or, formerly, Di-gesic.

Dr Peter Cooke, New Zealand committee chairman of the Australian and New Zealand College of Anaesthetists, said dextropropoxyphene had a "narrow margin for safety" and greater controls on it should be considered.

Drug deaths

Number of poisoning deaths involving opium-type drugs in 2001-2002:

* Total, 92.
* Morphine (including heroin), 33.
* Methadone, 31.
* Dextropropoxyphene (formerly including Di-gesic), 16.
* Codeine and its synthetic form, 12.

Source: NZ Medical Journal study