Here we go

========================================
"Despite methadone being a long acting drug there are risks related to
missing daily doses. The question of tolerance is tricky because
tolerance to different opioid effects develop (and are lost) at
different rates.   So, for instance tolerance to nausea and sickness
quickly develops and can be lost again, within a few days.

With regard to more significant effects such as respiratory depression -
then complete tolerance is never actually achieved i.e a very high dose
will still cause respiratory depression in a tolerant individual.

The risk of missing three days dosing lends itself to the view therefore
that the risk of overdose is significantly increased. The extent of the
loss of tolerance has never been documented in the scientific
literature.

Sedation is another effect for which tolerance takes a while to develop.
Sleep in an individual who has received too much methadone is dangerous,
since when sleeping the respiratory rate is reduced and this augments
the respiratory depressant effects of the drug.  Most overdoses occur at
night time.

Of course, if some one misses 3 doses then they usually "use" other
stuff and therefore  it is very important to "reassess" in order to find
out what has been going on.

The reason for the overdose that you mentioned (there have been a few)
is that  the client had used methadone obtained illicitly either the
night before coming for the appointment or just shortly before the
appointment had received the "normal" dose and had died as a result of
overdose.

I think that the client/drug worker relationship is very important here.

This is what we recommend:

* A pharmacist should not prescribe to a patient who has missed 3 days
dosing

The reason for this being that the pharmacist will not have information
about drug use in the last 3 days

The client should be referred to the prescribing doctor

The client should be educated about the risks of missing doses

Hope this helps
======================================

Regards

Jeff
----- Original Message -----
From: "Jeff Green" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, June 18, 2004 12:27 PM
Subject: Re: NICE to review drug misuse treatment


> A useful reply was posted on PrivateRx - rules there are that messages should not be reposted elsewhere.
>
> Regards
>
> Jeff
> > ???????
> > Hoos gaggin yer Jeff?
> > Love Rog
>