Looking behind the methadone figures

30 October 2012

David Liddell, SDF Director, takes a closer look at the role of methadone in Scotland’s drug-related deaths and finds up some issues worthy of further attention.

“While the focus has been on the overall number of deaths in which methadone has been implicated, or has potentially contributed to – 275 – there is a danger that attention is diverted from what else we need to examine.

The figures show clearly that methadone – possibly with alcohol – was the only drug to be implicated in 112 of the 275 deaths.

However, it was a factor alongside other drugs in causing the remaining 163 fatalities.

That means that in nearly 60 percent of the deaths where methadone was implicated, methadone was not the only substance involved – in fact two or more substances were a factor in the death.

This is not to say that we should underplay the significance of methadone in our lamentable tally of drug deaths - but it’s important not to lose sight of the fact that the majority are due to poly drug use.

For instance, benzodiazepines were the only drugs to have played a direct role in a total of seven deaths but played a part with other drugs in 185 deaths. This was up from 122 in the 2010 figures.

Alcohol was implicated along with one drug in 75 deaths but was thought to be a contributory factor alongside other drugs in a total of 129 deaths.

drought

The level of prescribed methadone, as far as we know, did not increase substantially between 2010 and 2011. So it looks like the heroin drought which SDF first identified at the end of 2010 would seem to be the major change between the two years.

We knew, from previous heroin droughts, that drug users would seek alternatives to heroin and SDF warned of the potential risk of overdose and other health issues associated with drug users using a number of depressant drugs in combination to supplement or replace their use of heroin.

It was foreseeable then that the impact of the heroin drought would become visible through a drop in heroin related deaths – as we have since seen in 2011 - and an increase in deaths caused by other substances, again also witnessed in the 2011 figures.

treatment

Another important factor in the methadone deaths is the people most likely to be victims.

The Report from the National Drug Related Deaths Database (NDRDD) for Scotland on the 2010 deaths showed that most people who died were not in treatment services. If analysis of the 2011 figures shows a similar pattern, two things become clear:

  • That it is illicitly obtained methadone – not Scotland’s Opiate Replacement Therapy policy per se – which is responsible for most deaths involving methadone
  • That properly administered methadone treatment – echoing the statements by the experts heading the Drug Related
  • Death Forum – is a protective factor against drug-related deaths.

Leakage from the public methadone programme into the illicit market is clearly happening.

But it should not be used an excuse to undermine the viability of ORT as an internationally and locally evidenced treatment which is particularly effective when used in conjunction with other supports.

Demand for illicit methadone arises mainly - although not exclusively - from people who are not in treatment and care services.

The big issue, therefore, is not methadone per se - but how to get more people into treatment and recovery services including identifying the reasons why people aren’t coming forward and addressing them.

Of equal importance is to ensure that those at risk of opiate overdose know the particular signs and symptoms of a methadone overdose.

Nevertheless, it’s clear that effective action to reduce Scotland’s drug deaths must take into account not only how we manage methadone but in our wider approach to treatment and care for people with drug problems…. and going even further, how we address contributory structural issues such as poverty, social inequality and our criminal justice system.

Making methadone the scapegoat for Scotland’s drug problem may make for easy headline sport but as ever, the reality is much more complex.

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