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LETTERS: Colin Brewer Emergency naloxone for heroin overdose: Naloxone is not the only opioid antagonist BMJ 2006; 333: 754-b-755-b [Full text]

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Is methadone what patients really want?

David J McCartney   (12 October 2006)

Is methadone what patients really want? 12 October 2006
David J McCartney, GPwSI Addictions Community Drug Problem Service, Edinburgh EH2 Send response to journal: Re: Is methadone what patients really want?	Colin Brewer correctly draws attention to the wealth of evidence on the efficacy of methadone, prescribed in adequate doses, in terms of health and other benefits.(1) In particular it does reduce drug-related mortality and crime, and may help to reduce blood borne virus spread. There is only one problem with this approach. It is not what patients want, and in this day of doctor/patient partnerships and patient-led health care, we need to listen to our patients. The DORIS Study in Scotland asked over 1000 patients what they wanted at the point of contact with services. 56.6% stated abstinence as their only goal.(2) In the National Treatment Agency's recent survey of nearly 7000 patients, 80% of heroin addicts wanted to stop using completely and 50% of patients on methadone wanted to get clean. What most get, of course, is continuing substitute prescribing.(3) We need to revisit the most effective and safe ways of helping patients achieve their goals. Doctor knows best just doesn't cut it any more. Researching what works to achieve abstinence will require significant resources, but is not beyond us. (1)Brewer C, BMJ 2006;333:754-755, doi:10.1136/bmj.333.7571.754-b (2)Mckeganey et al, Drugs: education, prevention and policy, 2004;(11), No. 5:423–435, (3) Best et al, NTA's first user satisfaction survey, National Treatment Agency, London 2006 Competing interests: None declared