We Speak Methadone (and buprenorphine)

A NAMA Recovery Forum for Medication Assisted Treatment patients, family and advocates. (Issues or Questions about registration and/or the forum? Email zac@tnmethadone.org OR sapphirematthews@gmail.com)
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 Post subject: The UK ..... to the stigma
PostPosted: Tue Jul 28, 2015 9:54 am 
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The following is from Dr. Robert Newman - while dose in the US has gone up (from 35 mgs 20 yrs ago to close to 70 mgs today) the dose in the UK has gone down. My questions is the same as Dr. Newman's "Why would anyone pay attention to evidence-based recommendations." :twisted:


Quote:
.......to the stigma. Note the dosages of methadone in UK over the past decade or so. How to explain, other than the conviction that methadone is bad, more is worse, and why should anyone pay attention to evidence-based recommendations? Sad, sad. . . .Bob

1999, UK – National Treatment Guidelines:
optimal maintenance dose for most 60-120 mg (1)

2005, UK - average dose decreased
from 59mg 1999 to 45mg 2005 (2)

ADDENDUM: 2007-2012, ENGLAND AND WALES -
“average dose over the 6 yrs: 46.6mg” (3)


1. http://www.dh.gov.uk/assetRoot/04/07/81/98/04078198.pdf
2. Dickinson et al. (2006) J Clin Pharm Therap, 31:477-484
3. Marteau D et al. BMJOpen, May 30, 2015

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 Post subject: Re: The UK ..... to the stigma
PostPosted: Wed Jul 29, 2015 7:37 am 
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The main reason that the mean dose in the UK has gone down has been the change in government from a more liberal one to a conservative one that believes that abstinence must be the ultimate goal of all treatment.

This is starting to change because they had tried forcing people to reduce off their scripts, but this lead to people dropping out of treatment and the new incidences of contractions of Hep C and HIV increasing, along with crime.

Now they can see the negative effect that forcing patients out of treatment has, they are slowly starting to stop.

We have a history of chronic underdosing, and I feel that if more people were optimally dosed, the UK MMT program as a whole would be much more successful.

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 Post subject: Re: The UK ..... to the stigma
PostPosted: Sat Aug 01, 2015 9:14 pm 
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Location: North Georgia
This is one reason that I sometimes wonder if socialized medicine IS such a great thing (and those who know me know I tend to be pretty liberal ).... Because healthcare is socialized that gives the government a little TOO much control over stuff... and like sapphire is saying (our resident UK advocate), treatment trends can change at a whim based on the government that is in power. NOT GOOD.

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 Post subject: Re: The UK ..... to the stigma
PostPosted: Mon Aug 03, 2015 8:03 am 
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This is what worried me initially about the ACA, that the government, whether at State or Federal level, would have more of a say in what happen in treatment, as they were paying for it. Getting free treatment really is not all it's cracked up to me, and I would gladly pay for my treatment if I could have some of the benefits you guys in the US have. It's definitely the kind of system that other countries should be aspiring to.

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 Post subject: Re: The UK ..... to the stigma
PostPosted: Mon Aug 03, 2015 4:14 pm 
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Obviously you're referring specifically to our methadone treatment system... not necessarily our healthcare system overall which leaves MUCH to be desired! :? But the "clinic system" we have for opioid maintenance treatment is far and away one of the best. The U.S. is the birthplace of MMT, after all, so we should be leaders in at LEAST this area! 8-)

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 Post subject: Re: The UK ..... to the stigma
PostPosted: Wed Aug 05, 2015 8:32 am 
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Yes, sorry, to be clear I was referring solely to the MAR system, and not healthcare in general.

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