Angelo Pricolo takes a look at recommendations to help methadone patients, and whether these could help or hinder
Unfortunately we have seen another methadone takeaway (T/A) death reported on in recent days.
Any death is regrettable, especially when it can be directly linked to the consumption of a medicine that was dispensed from a pharmacy.
But it would be a tragedy if the coroner’s recommendations led to a tightening, across the board, of methadone T/A policy. Too many patients re-engaging with daily life would be adversely affected when really the solution is about framing policy to cater for individual needs with safety paramount in any decision process.
We have spent so much time and effort trying to engage patients into this program. Any measure that would push them away from treatment needs to be carefully considered.
There would be a price to pay in human life or overdose by tightening restrictions also. We need balanced and considered discussion before hastily making decisions which will adversely impact many lives.
Pharmacist opinion in allowing patients more unsupervised doses, although currently outlined in the DHHS guidelines (in Victoria) unfortunately is still rarely sought.
Singularly this would have a greater impact on selecting which patients could safely take methadone doses home than any other measure. It is simply a function of contact time with patients that pharmacists are privy to that provides an opportunity to assess stability.
We have seen a huge increase in the number of T/A doses issued as a direct consequence of the COVID-19 pandemic and it is no surprise that this has broadly been met with huge support from patients; life-changing for some.
Returning to pre-pandemic T/A regimes is a lurking dreaded outcome that patients are not looking forward to. Add to this the coroner’s recommendations over many years to tighten access to unsupervised doses, patients are understandably feeling very nervous.
Let’s follow the evidence before making blanket changes to policy. Does reducing T/A doses really decrease overdose deaths or are we just assuming this?
In Tasmania T/A doses are far less common than in Victoria or NSW but has this drastically reduced overdose rates per head of population?
The coroner has also recommended more education, which would be unanimously supported, but it needs to be backed up with funding.
Education doesn’t just happen. Maybe then we could combat this relic of cordial diluted T/A doses, when patients routinely stored doses in the fridge to stop them going rancid, especially in the heat.
The idea of having a safe to store T/A doses could also gain support but really are we expecting patients to supply this?
Again, financial support is needed for a population that is already disadvantaged by the stigma felt from the majority of the community.
This stigma probably drives the political diversion away from listing opioid replacement treatments on the PBS proper, instead of expecting patients to pay unsubsidised prices for their life saving medicine.
Stigma is evident and is palpable for these patients, while deaths and diversion from oxycodone attracts much less attention and criticism.
We need to afford these patients a fair go and not undo the good work needed to encourage them into treatment rather than push them away by creating a program that makes achieving a “normal” life impossible.
Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.