Drug agency calls for higher methadone dose

Government drug chiefs are to order an increase in the dosage of methadone prescriptions for tens of thousands of heroin addicts amid fears that treatment is not working.</p>The National Treatment Agency confirmed last night that a report by a panel of experts set up to investigate the effectiveness of methadone prescriptions in Britain will recommend that the dosage be increased by more than 13 per cent, from 53mg to a minimum of 60mg per day.</p>In some cases, addicts should be allowed up to 120mg a day, it states.</p>The report, which will be published in the summer, warns that addicts who are given inadequate doses face dropping out of treatment programmes and returning to heroin use or turning to black market suppliers to obtain extra methadone.</p>Annette Dale-Perera, the agency's director of quality, said that doctors were often under-prescribing methadone because they feared their patients might overdose.</p>She said: "Some doctors are very wary of prescribing high doses of what they see as a dangerous drug."</p>But Ms Dale-Perera, who chaired the working group, said that although these concerns were "very valid", evidence showed that methadone doses of between 60 and 120mg a day were most effective in safely managing a patient's addiction.</p>She said: "The evidence shows that that this dosage band is the best for reducing mortality, crime and [the need for] injecting, and improving people's well-being and social functioning."</p>The agency's prescribing expert group included representatives of the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Psychiatrists. Other members were representatives of drug-user groups like the Methadone Alliance.</p>Ms Dale-Perera said that risks of overdosing could be minimised by supervising consumption of methadone in the early days of prescription and only dispensing it on a daily basis. She said it was vital to minimise the diversion of methadone on to the illicit market.</p>Last week the House of Commons' Home Affairs Select Committee published a report on Government drugs strategy recommending greater availability on prescription of diamorphine (clinical heroin).</p>But the National Treatment Agency will later this year publish new guidelines on diamorphine prescription, which have been drawn up in conjunction with the Department of Health. The agency believes that diamorphine should only be made available in extreme cases, for "those not responding to or accessing any other form of treatment".</p>Unlike methadone, which is taken orally, diamorphine is almost always injected and carries risks of infection from shared needles.</p>The agency has accused the select committee of putting "undue emphasis" on diamorphine, and that the key issue is methadone â“ prescribed to the majority of opiate addicts.</p>The increased dosages would be made available to people who were undergoing a complete treatment package which included other support like structured counselling, the agency said. </p>