Methadone prescribing to opiate addicts by private doctors: comparison with NHS practice in south east England

FRANÇAIS :
A partir d'une enquête dans les pharmacies (en 1995 et en 1997) concernant toutes les prescriptions de méthadone aux usagers d'opiacés (829 dont 785 du secteur public et 44 du secteur privé), les doses prescrites, les formes galéniques et la durée de délivrance ont été analysées. En médecine privée, les doses plus élevées, le manque d'organisation de la délivrance et la fréquence de la forme injectable sont des facteurs de risques d'abus et de détournement.
ENGLISH:
Aims. To compare National Health Service (NHS) and private practice in prescribing methadone to opiate addicts. Design and participants. Survey of community pharmacies during 1995 (one in four random sample) and during 1997 (one in two random sample) in which data were collected on all methadone prescriptions currently being dispensed to opiate addicts. Setting. Dispensing community pharmacies in south east England. Units measured. 829 methadone prescriptions (785 NHS and 44 private) from 1995, and 761 (703 NHS and 58 private) from 1997. Measurements. (i) The prescribed daily dose of methadone; (ii) the form (oral mixture, tablets or ampoules); and (iii) the pick-up duration (daily collection of prescribed dose, through to weekly or fortnightly collection in a single pick-up). Findings. Private methadone prescriptions issued to addicts typically give twice the daily dose, are more than four times as likely to give the methadone in injectable form, and most commonly give prescriptions to be collected in a single large weekly or fortnightly instalment instead of through daily dispensing, compared with NHS methadone prescriptions. Conclusions. The disparity between private and NHS methadone prescriptions is striking. The much higher doses, the lack of arrangements for instalment collection and the frequent choice of injectable forms of methadone increase greatly the risk of abuse and diversion to the black market. Regulatory scrutiny of this private practice in the United Kingdom is currently ininimal. Independent research is required to explore more fully the different nature of such private methadone prescribing. (Author' s abstract)