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Experts warn drug death rates will rise again
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Methadone is linked to one in three drug deaths
Christopher Mackie - Scotsman - 18th August 2010

Silhouette of liquid methadone being taken - the heroin substitute nis responsible for one in three Scottish drug related deathsCalls have been made for a rethink on the use of methadone in Scotland after official figures revealed the number of deaths in which it was implicated reached a ten-year high last year.  Amid a general fall in people being killed by drugs, fatalities in which the heroin substitute was cited as a contributory factor rose to 173 in 2009, up from 169 in 2008 and a surge of 51 per cent since 2007 when it was associated with 114 deaths.

The controversial drug treatment was found to be at least partly responsible for more than a third (32 per cent) of all of the 545 drug-related fatalities in Scotland last year, and was associated with the second-highest number of drug-addict deaths after heroin or morphine, which contributed to 322 losses of life - 59 per cent of the total.

The 2009 methadone figure also equates to roughly one death every 48 hours.

The rising number of deaths linked to methadone led to calls for the policy of wide prescription of the treatment to addicts to be reviewed, with one drug-misuse expert describing the current situation as being of "enormous concern".

Professor Neil McKeganey, the director of the Centre for Drug Misuse Research at Glasgow University, said: "The situation in relation to methadone - where it appears we have around a third of addict deaths associated with the drug we are prescribing most widely to treat drug addiction - is of enormous concern.

"We really ought to be looking again at this policy of widespread methadone prescribing. The statistics are inescapable - we ought to be looking at why we are doing it and whether all of those to whom it is being prescribed are deriving benefit from it."

Peter McCann, the chairman of the Castle Craig Hospital for alcoholism and drug addiction, lent his weight to the calls, adding: "Today's drug-death figures would have been described as totally catastrophic just a few years ago. There must now be a total rethink in Scotland along the lines of the National Treatment Agency in England which totally reversed its policy earlier this month.

"They will be limiting the use of methadone with strict multi-disciplinary assessments at regular intervals. The policies prescribing methadone in Scotland have obviously failed and must be revised."

Murdo Fraser, Scottish Conservative health spokesman, said the focus of the Scottish drugs strategy should be on recovery and abstinence.

He said: "The attempts of the last decade to merely manage the problem, based on harm reduction and an over-reliance on methadone, just have not worked.

"The challenge now is to expand the range of rehabilitation services on offer and move to abstinence and recovery."

But the treatment was defended by Biba Brand of the Scottish Drugs Forum: "We know from research that staying on methadone tends to prolong their life by about 13 per cent.

Mathadone doseMethadone (Dolophine, Amidone, Methadose, Physeptone, Heptadon and many others) is a synthetic opioid, methadoneis used medically as an analgesic, antitussive and a maintenance anti-addictive for use in patients on opioids. It was developed in Nazi Germany in 1937. Although chemically unlike morphine or heroin, methadone also acts on the opioid receptors and thus produces many of the same effects. Methadone is also used in managing chronic pain due to its long duration of action and very low cost.

Methadone's usefulness in treatment of opioid dependence is the result of several factors. It has cross-tolerance with other opioids including heroin and morphine, long duration of effects with the result that oral dosing with methadone will stabilise the condition of the patient by stopping and preventing the opioid withdrawal syndrome, and by at least partially blocking the "rush" resulting from intravenous injection of heroin, morphine, and similar drugs.

Today a number of pharmaceutical companies produce and distribute methadone, with only the racemic hydrochloride being available in the United States as of March 2008 but the tartrate and other salts of the laevorotary form (levomethadone, with trade names like Polamidone, Heptadon etc.), which is more potent and lacks the cardiac effects like lengthened QT interval caused by the dextrorotary form, being available in Europe and elsewhere. The major producer remains Mallinckrodt. Mallinckrodt sells bulk methadone to most of the producers of generic preparations and also distributes its own brand name product in the form of tablets, dispersible tablets and oral concentrate under the name Methadose in the United States.

Adverse effects
Adverse effects of methadone include: hypoventilation, decreased bowel motility - constipation, miotic pupils, nausea, hypotension, hallucination, headache, vomiting,
cardiac arrhythmia, anorexia (symptom), weight gain, stomach pain, xerostomia, perspiration, flushing, itching, difficulty urinating, swelling of the hands arms feet and legs, mood changes, blurred vision, insomnia, impotence, skin rash, seizures, death, mortality

According to the National Center for Health Statistics, as well as a 2006 series in the Charleston (WV) Gazette, medical examiners listed methadone as contributing to 3,849 deaths in 2004, up from 790 in 1999. Approximately 82% of those deaths were listed as accidental- and most deaths involved combinations of methadone with other drugs (especially benzodiazepines).

Tolerance and dependence
As with other opioid medications, tolerance and dependence usually develop with repeated doses. Tolerance to the different physiological effects of methadone varies. Tolerance to analgesia usually occurs during the first few weeks of use; whereas with respiratory depression, sedation, and nausea it is seen within approximately 5-7 days. There is no tolerance formed to constipation produced by methadone or other opioids; however, effects may be less severe after time and can often be alleviated through increase intake of dietary fiber (fruits and vegetables, high-fiber cereals, etc.) or fiber supplements.

Withdrawal symptoms of methadone include
Physiological Effects: increased lacrimation, rhinorrhea, sneezing, nausea, vomiting, diarrhea, fever, chills, tremor, tachycardia, aches and pains, often in the joints
elevated pain sensitivity, elevated blood pressure

Cognitive Effects: suicidal ideation, depression, adrenal exhaustion, adrenal fatigue, spontaneous orgasm, prolonged insomnia leading up to delirium, auditory hallucinations, visual hallucinations, enhance olfactory sense, decreased sexual drive, agitation, panic disorder, anxiety, paranoia,

Withdrawal symptoms are generally slightly less severe than those of morphine or heroin at equivalent doses but are significantly more prolonged; methadone withdrawal symptoms can last for several weeks or more. Indeed, there is a trend in the management of opiate addiction towards the reduction of a patient's methadone dosage to a point where they can be switched to buprenorphine or another opiate with an easier withdrawal profile. Ultimately, methadone is all but ideal for maintenance, but is not considered to be a desirable opiate to withdraw from when attempting to become completely opiate-free.

Experts warn drug death rates will rise again as Scotland posts
second-highest number of fatalies ever

Daily Record - 17th August 2010

Scotland has seen the second highest number of drug deaths since records began - despite a fall in the number for the first time in four years.

Figures released today show deaths dropped to 545 in 2009 from 574 the previous year, a decrease of 5%.

But the total is still the second-highest ever recorded - and experts warn the long-term trend is for a steady rise.

This also comes just one year after the figures hit the highest recorded in Scotland.

The Greater Glasgow and Clyde NHS area accounted for the highest local number with a record 200 deaths there. NHS Grampian recorded an increase to a new high of 52 over the year.

Heroin and morphine were implicated in 322 deaths in Scotland, while the heroin substitute methadone may have contributed to 173 deaths.

Alcohol was implicated in 165 deaths, almost one-third, according to the figures from the General Register Office for Scotland.

Community safety minister Fergus Ewing said: "These figures published today remind us that drug misuse destroys lives, and the impact is felt far beyond the individual user.

"Fewer people lost to drug use is always good news, but we must acknowledge that these figures remain high.

"It is clear we continue to face a challenge to help steer people away from problem drug use and towards recovery."

The Scottish Government provided a record £28.6 million for frontline drug treatment services this year.

Mr Ewing, who was visiting Glasgow Addiction Services, announced a national programme for Naloxone, an opiate antidote which temporarily reverses the effects of overdose.

He said: "Naloxone isn't the solution to drug-related deaths but it is an important intervention. It has role to play within a wider range of treatment and support in reducing harm and supporting recovery."

The Government is spending £500,000 over two years for the programme.

All prisons will supply the drug and training to prisoners "vulnerable" to overdoses before release.

Biba Brand, of the Scottish Drugs Forum, added: "In the USA and Europe, take-home Naloxone programmes have been linked with reductions in drug deaths of up to 34%.

"If people are to have a chance of recovering from a heroin problem - and we are to stop the damage caused to families and communities through these deaths - the first priority is helping people to stay alive. This programme aims to do that."

Dr Roy Robertson, chairman of the National Forum on Drug-Related Deaths, said: "Taking into account what we have experienced in the past concerning the general upward trend in figures this year's drug related deaths show a similar pattern to previous years.

"Any reduction is, however, welcome as each death is a personal tragedy and a family and community disaster."

Labour community safety spokesman James Kelly said: "Particularly worrying is the number of children and young adults who become involved in occasional drug-taking and develop a serious dependency at an early age.

"Worrying too is that areas of high social deprivation continue to suffer from higher levels of drug abuse.

"More work needs to go into prevention and intervention programmes as well as into a renewed effort on educating young people about the dangers of drugs.

"Drug Treatment and Testing Orders have proven to be a robust and effective approach in tackling drug misuse but the SNP government have been slow to expand their use.

"Labour believes that greater use of such orders could be a positive measure in the fight against drug misuse."

See also:
The Methadone debate
£60000 cost of keeping an addict on drugs
Cold turkey for addicts
Fury at council plan to give addicts free heroin
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