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Notes from practice: Methadone prescribing in north central London—doses, compliance, goals and treatment setting

Aims: To examine methadone prescribing in public drug treatment services in inner London; compare levels of methadone prescribing with national guidelines and surveys; investigate whether methadone reduces illicit opiate use; and compare clients treated in specialist clinics with those in shared-care in general practice. Methods: A cross-sectional survey of four drug treatment services in north central London. Findings: Data were collected on 715 clients. Mean methadone dose was 57.2 mg but for clients on methadone maintenance, the mean dose was 63.4 mg. Reported heroin use fell from 24.8 days in the last 30 at initial assessment to 11 days (p < 0.001). Clients on methadone doses greater than 60 mg were more likely than those on lower doses to test negative for morphine on urinalysis (49% vs. 39.4%, p < 0.01). Clients in GP shared-care were more likely to have been in treatment for less time, be on lower doses of methadone and have stabilization or detoxification as their treatment goal. Conclusions: Methadone treatment is associated with a reduction in illicit opiate use but not abstinence. Inadequate doses and lack of supervised consumption may in part explain the relatively poor response to treatment. Clients in GP shared-care received substantially different treatment from those in the specialist clinics.