Opioid replacement therapy (ORT), most commonly with methadone, is one pharmacy service that is constantly under threat. The reason is obvious: the patients are drug misusers, and so are often vilified as symptomatic of societal problems.
An example is Project Prevention, a US group arriving in the UK that offers drug misusers cash incentives to use birth control or to get sterilised. I’m not even going to give that idea publicity.
This week battle lines were drawn up yet again, with a paper in the BMJ possibly tangling up the government in conflicting policies.
The government view on methadone is not a positive one. In April, Prime Minister David Cameron said opioid substitution therapy “does not deal with the problem” of drug misuse, stating “we must be mad as a country not to get people into that residential rehab”.
During the election I spoke to now-health secretary Andrew Lansley, who echoed Mr Cameron’s words. But a paper this week has come out in favour of longer term ORT in a big way. Using the UK General Practice Research Database, the BMJ study looked at 5,577 patients with 267,003 prescriptions for ORT, following them until one year after the expiry of their last prescription – a total of 17,732 years.
The study found that mortality rates for patients on ORT were around half those for patients not on the therapy – the crude mortality rates were 0.7 per 100 person-years and 1.3 per 100 person-years. respectively. There were peaks in mortality in the first weeks starting treatment, and in the first weeks of withdrawing treatment.
Overall, ORT was found to have more than an 85 per cent chance of reducing mortality if patients remain on treatment for more than a year.
For pharmacists, there is an important message: extra vigilance is needed when treating patients who are starting, or finishing, ORT.
The paper creates a conundrum for a government that has previously set out its stall in favour of residential rehabilitation (despite the cost). In its white paper consultation on outcomes, the Department of Health states a core principle as: “People should not die early where medical intervention could make a difference.” Opioid replacement therapy has shown it fits the bill.