Methadone prescribing to opiate addicts by private doctors: comparison with NHS practice in south east England

Aims. To compare National Health Service (NHS) and private practice in pres cribing methadone to opiate addicts. Design and participants. Survey of com munity pharmacies during 1995 (one in four random sample) and during 1997 ( one in two random sample) in which data were collected on all methadone pre scriptions currently being dispensed to opiate addicts. Setting. Dispensing community pharmacies in south east England. Units measured. 829 methadone prescriptions (785 NHS and 44 private) from 1995, and 761 (703 NHS and 58 p rivate) from 1997. Measurements. (i) The prescribed daily dose of methadone ; (ii) the form (oral mixture, tablets or ampoules); and (iii) the pick-up duration (daily collection of prescribed dose, through to weekly or fortnig htly collection in a single pick-up). Findings. Private methadone prescript ions issued to addicts typically give twice the daily dose, are more than f our times as likely to give the methadone in injectable form, and most comm only give prescriptions to be collected in a single large weekly or fortnig htly instalment instead of through daily dispensing, compared with NHS meth adone prescriptions. Conclusions. The disparity between private and NHS met hadone prescriptions is striking. The much higher doses, the lack of arrang ements for instalment collection and the frequent choice of injectable form s of methadone increase greatly the risk of abuse and diversion to the blac k market. Regulatory scrutiny of this private practice in the United Kingdo m is currently minimal. Independent research is required to explore more fu lly the different nature of such private methadone prescribing.