Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales.
OBJECTIVE
To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions.


METHODS
National survey of 25% random sample of community (high street) pharmacies through postal questionnaire, with four mailings.


METHODS
England and Wales.


METHODS
1 in 4 sample of all 10,616 community pharmacies, stratified by family health services authority.


METHODS
Data were collected on each prescription for controlled drugs currently being dispensed by pharmacies to misusers, describing the drug, form, dose, source (general practice or hospital; and NHS or private), and numbers of dispensing pick ups a week.


RESULTS
Methadone was the opiate most commonly dispensed to misusers (96.0% of 3846 opiate prescriptions). 79.6% of methadone prescriptions were for the oral liquid form, 11.0% for tablet, and 9.3% for injectable ampoules. More than one third of all methadone prescriptions were for weekly or fortnightly pick up, with a further third being for daily pick up. Tablets and ampoules were even less likely to be dispensed on a daily basis. Private prescriptions were significantly more likely than NHS ones to be for tablets or ampoules, to be for substantially higher daily doses, and to be collected on a weekly or fortnightly basis.


CONCLUSIONS
The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings. In view of the frequent crushing and injecting of methadone tablets, clearer more authoritative guidance is needed on the contexts in which injectable methadone (tablets as well as ampoules) should be prescribed and on the responsibilities for monitoring and supervision which should be attached.
Strang
J
J
National Addiction Centre, Institute of Psychiatry, London.
Sheridan
J
J
Barber
N
N
D000284:Administration, Oral; D000553:Ambulatory Care; D011307:Drug Prescriptions; D004363:Drug Utilization; D004739:England; D005194:Family Practice; D006306:Health Surveys; D006801:Humans; D007267:Injections; D008691:Methadone / Q000008:administration & dosage* / Q000600:supply & distribution; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010594:Pharmacies; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D017149:Private Sector; D011364:Professional Practice; D013222:State Medicine; D013607:Tablets; D014852:Wales
D013607:Tablets; D008691:Methadone