Summary: Policy on takeaway dosing for maintenance pharmacotherapy in Victoria

Author: Lynda Berends

Resource Type: General

image - Policy Square

This is a summary of: Berends, L., Chalmers, J., & Lancaster, K. Trust, agency, and control: Perspectives on methadone takeaway dosing in the context of the Victorian policy review, which has been accepted for publication in Drug and Alcohol Review (accepted 15 April 2015) http://onlinelibrary.wiley.com/doi/10.1111/dar.12287/abstract

Since 2014 the Victorian Advisory Group for Drugs of Dependence has been reviewing Victoria’s policy on maintenance pharmacotherapy for opioid dependence (‘the Policy’). The review was triggered by Victorian Coroners Court concerns about methadone overdose deaths where the methadone had been sourced from takeaway doses. Takeaway doses (where stable clients are given future supplies to consume without supervision) have always been part of the Australian pharmacotherapy maintenance program, as they promote a sense of normality and support treatment access and retention.

For some years now, the Victorian Coroners Court has expressed concerns about overdose deaths involving takeaway doses. In their investigation of 184 deaths from 2010 to 2013 where the methadone source could be confirmed, the methadone had been dispensed to the deceased in 89 cases while in the remaining 58 cases the deceased was found to have used someone else’s dose. Consequently, the Coroners office recommended placing further restrictions on takeaway doses.

Reducing avoidable deaths is paramount, however opioid deaths are complex events and other drugs are often involved. In the 587 Victorian deaths involving methadone between 2000 and 2012 the Victorian Coroners Court found that 85.1% involved multiple drugs (particularly benzodiazepines). Further, the risk of overdose associated with takeaway methadone must be weighed up against the possible benefits of improved treatment access (and retention) and a heightened sense of normality for clients. Sharing takeaway doses with other people has demonstrated harm reduction benefits, for example as a safeguard against their withdrawal and in avoiding their need to access heroin from an unknown source.  When reforming policy to reduce methadone-related deaths, we must consider that lives may be saved by providing treatment that is accessible, practical, and supports long term retention, while enabling improved well-being and social inclusion.

Takeaway methadone dosing policy is a complex area that defies the realisation of a single position that is appropriate for all clients. We believe that the Policy matters. It should support the application of prescriber and clinical expertise without moral judgement, in consultation with clients and with recognition of clients’ rights to an evidence-based therapeutic intervention that is easy to access and administer. Restricting access to takeaways may reduce methadone related deaths, but we know it will also reduce treatment seeking and retention in treatment.

 

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