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Experts back opioid replacement amid methadone death concerns

Addiction experts in Scotland have backed use of opioid replacement therapy, amid concerns about high rates of deaths associated with methadone.

An independent group of experts was drafted in last year to review the evidence for ORT, in light of concerns that methadone deaths were rising after a 58% jump in the number of deaths related to methadone was recorded in 2011.

The review, published last week, concluded that ORT - and in particular methadone - is ‘supported by a strong evidence base’, is largely delivered appropriately and should continue to be used. 

However, it also said ORT should form part of a wider range of treatments such as community and residential rehabilitation, with a more individualised approach to supporting people. The panel called for efforts to reduce variations in practice in the way ORT is delivered by community pharmacists and general practices.

Official figures released this week show methadone was implicated in 237 deaths in Scotland in 2012, slightly lower than the all-time high of 275 in 2011, but still making up a large proportion – 41% – of the total of 581 drug-related deaths.  

Heroin and/or morphine were implicated in 221 deaths, 38% of all drug-related deaths.

However, the number of deaths in which methadone was the only drug implicated was much lower, at 12.

Dr Brian Kidd, chair of the Scottish Drugs Delivery Strategy, who led the independent review, 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.’

Dr Roy Robertson, reader at the Centre for Population Health Sciences at the University of Edinburgh and a GP in the city, who advises the National Forum on Drug-related Deaths, welcomed the review’s findings.

He told Pulse: ‘Methadone is not the only show in town, buprenorphine and even codeine derivatives and morphine are alternatives. However, methadone is the treatment with the most evidence base behind it and that with which we have most experience.’

Dr Robertson said GPs have an important role in tackling what is a growing and complex problem.

He said: ‘GPs should now take the initiative and set up robust services in the community to manage the non-specialist part of this problem, which forms the large part of it.’

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