Methadone saves lives.. it shouldn’t be demonised

One of Scotland’s top experts on drug abuse passionately believes controversial opiate replacement therapy is the right treatment for those in grip of heroin

PROFESSOR Roy Robertson has spent much of his professional life immersed in the treatment and understanding of drug problems. The GP’s work on the Muirhouse housing estate in Edinburgh highlighted how the sharing of dirty needles by heroin users in the 80s created an explosion in the spread of HIV. Robertson has dedicated much of his career since then to reducing the stigma that sets drug users from poverty-stricken communities apart from society. Rather than reducing the number of people being prescribed methadone, he believes more damage is being done by cash-strapped health boards blocking the treatment for people who desperately need it. Robertson said: “The prescription of effective treatments should be made available when the patient requires them, in the same way as insulin is available for diabetics or chemotherapy for cancer. “To withhold this treatment is unethical. Health boards and medical staff have an obligation to provide treatment and to fail to do this is a breach of professional duty.” Robertson has seen at close hand how methadone can help those addicted to heroin. And he firmly stands by research-based evidence that holds up opiate replacement therapies, including methadone and buprenorphine, as the best treatment for such people. Robertson has been critical of the Scottish Government’s recently announced draft strategy on drugs, claiming it fails to address the huge scale of the crisis our nation is facing. He believes the criticism of methadone in the media has done more harm than good. Robertson said: “The correct treatment is opiate substitute and that is methadone or buprenorphine. The evidence and guidelines are well-established and are based on three or four decades of research and clinical practice.

“The guidelines are unambiguous. We need to follow them correctly.

“I should say that no one coerces people to take methadone and the problem is often that an underfunded system can’t keep up with demand.

“Pressure from a variety of agencies (including the press) to reduce prescribing and to encourage abstinence when it is not in the best interest of the patient is very damaging.”

Robertson believes methadone is demonised by many who do not take its success stories into account.

Most people who have benefited from methadone and been able to stay in work and lead stable lives are, understandably, keen to avoid any publicity because of the stigma.

Robertson agrees that poly drug use is the real killer – where people mix methadone with street drugs like fake Valium and prescription pills including gabapentin and pregabalin, all available for 50p or a pound a pop.

He added: “Methadone is not without side effects and risks, but used properly and restricted by observation of nationally agreed guidelines, is a life-saving and life-prolonging treatment.

“Association of methadone and buprenorphine with side effects and fatalities is a misrepresentation of the evidence. Although it is implicated in some deaths, it is almost always because it is used with other drugs or taken inappropriately by people who misunderstand the risks and are not following medical instructions.

“To prevent or avoid these risks, the treatment services need to be properly resourced and supported.

“Prejudice against people who use drugs, those who try to intervene on their behalf and the treatment itself is unfair and should be recognised and discouraged by health and political authorities, as well as media and communications agencies.”

Robertson said chaotic lives can lead to addicts mixing drugs and undoing the benefits of methadone.

He added: “There is no easy solution to the complex problem of drug-related deaths.

“It is multi-faceted but driven by poverty (made worse by current benefits issues), ageing populations of people who use drugs and all the accumulated problems of a lifestyle.

“Most of all is the constantly changing illegal supply of a mixture of drugs available in the cities.

“NHS services struggle to keep up with all this and cutbacks have not helped.”

UK Government guidelines state that even a lifetime of methadone need not be considered a failure for some people – a view that some believe needs to be revised, given Scottish death rates.

Robertson has said the deaths in Scotland are not taken seriously enough by government or the public because they see “an ageing cohort that is going to die and they just need to tough it out”.