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Supervision of Methadone Prescriptions Reduces Number of Related Deaths

Although the heroin substitute is known to effectively reduce heroin-related deaths among heroin addicts and facilitate better recovery during rehabilitation, use of methadone itself has raised concerns due to its potential for abuse, dependency, and overdose when misused by vulnerable patients. Because trends in heroin abuse and methadone prescribing among the UK population have continued to rise in recent years, Professor John Strang at the National Addiction Centre, Institute of Psychiatry in King’s College London and colleagues assessed the relationships between methadone-related deaths and the use of supervised methadone prescribing among the Scottish and English populations during 1993 to 2008.

In their study, the researchers gathered information regarding those deaths in Scotland and England in which methadone was the sole drug involved or was used in combination with other substances. The researchers polled their results based on the number of methadone-related deaths per million daily doses of methadone per year, composing what they call an annual OD4-methadone index. According to their research, the practice of methadone prescribing dramatically changed during the 1990s as the introduction of daily supervision of methadone doses within the early stages of treatment became standard among treatment facilities. Because of this increased supervision, the researchers noticed that methadone-related deaths had dropped four times the rate from previous years in both Scotland and England, indicating that the newer method of methadone administration was not only effective but safer to use in recovery treatment.

For example, for the time period in which Scotland implemented the newer methadone prescribing practice (1995 to 2000), the study found a substantial decrease in the number of deaths caused by methadone only (from an estimated 19.3 to 4.1 to 3.0 during each consecutive 4-year period) as well as combined methadone use (from 58 to 29 to 14 deaths during each consecutive 4-year period). The rate of methadone-related deaths in England experienced a similar decline between 1999 to 2005: from an estimated 27.1 to 24.8 to 5.8 deaths caused by methadone-only use during each consecutive 4-year period, and from 46 to 42 to 12 deaths caused by combined methadone use during each consecutive 4-year period. These reductions in methadone-related deaths were closely associated with the introduction of supervised methadone dosing within both countries, and occurred during a time period in which methadone prescribing had increased 18-fold in Scotland and sevenfold in England.

Despite the high risk of mortality among heroin-addicted patients, their rate of mortality involving methadone was shown to have substantially declined for the first time in clinical research. The researchers suggest that methadone prescribing among this population is now being implemented with fewer adverse effects and greater health benefits, directly due to the introduction of daily supervised methadone administration. Since recovery patients’ access to the prescribed methadone is being controlled and monitored, especially during the early stages of their treatment, physicians are helping to prevent the hoarding of the heroin substitute among patients, thereby reducing misuse, diversion, and overdose. Furthermore, the findings indicate that similar changes to treatment practices may also help decrease the rate of opioid-related overdose deaths among the UK population, where opioid misuse has been linked to over 75% of all illicit substance overdose deaths.

Under the King’s Health Partners Academic Health Sciences Centre, both the Institute of Psychiatry, King’s College London and the South London and Maudsley NHS Foundation Trust run the National Addiction Centre where the study was based. The researchers’ findings were published online in the British Medical Journal on September 16, 2010.

Source: Medical News Today, Heroin Substitute Supervision Saves Lives, UK, September 22, 2010

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