EFFECTIVENESS BANK BULLETIN 18 July 2012
WILL HEART DEATH RISK UNDERMINE RECOVERY POTENTIAL OF METHADONE?
A new bulletin has collated the latest additions to the Effectiveness Bank. All focus on medications
which substitute for heroin and in particular methadone, a long-acting drug taken by mouth which
promises to stabilise the roller-coaster of heroin injection and enable addicts to get on with their
lives. In Britain an expert group has addressed head on the criticism that methadone substitution
means giving up on recovery for too many patients. In its favour above all is the compelling mantra
that dead people cannot recover; methadone saves lives, giving patients a chance to overcome their
problems. That is why the assertion that methadone itself risks death by disrupting the heart beat
is potentially so damaging and so controversial. Is the risk real enough to enforce cautionary
measures which curtail methadone treatment and might themselves cost lives? A US expert panel
changed its mind and British and US studies suggest the risk is very small.
To view the whole bulletin click this link:
http://findings.org.uk/docs/bulletins/Bull_18_07_12.php
or click the links below to view an entry in the bulletin. If clicking does not work, paste the link
in to your web browser address box, being sure to enter the whole address.
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*revised* CRUCIAL REPORT AIMS TO REHABILITATE METHADONE AS A RECOVERY TOOL
On behalf of the UK government an expert group has developed a clinical consensus on how
prescribing-based treatment for heroin addiction can be made more recovery-oriented in line with
national strategy. Their report will be the main reference point in tussles over what recovery means
for methadone services and patients. It could make the difference between a dramatic rowing back in
patient numbers and permitted treatment durations, or a re-orientation which preserves both yet
improves outcomes. In either case, lives are at stake.
http://findings.org.uk/count/downloads/download.php?file=Strang_J_27.txt
NO NEED FOR HEART TESTS ON ALL METHADONE PATIENTS
Concerned that this might on balance cause more deaths by limiting an effective treatment for opiate
addiction, an expert panel convened by the US government has changed its mind over whether the risk
of fatal heart disorder potentially posed by methadone justifies routine electrocardiogram screening
of patients. What seems a straightforward medical issue became a highly controversial focus for
competing perspectives on how best to safeguard patients.
http://findings.org.uk/count/downloads/download.php?file=Martin_JA_1.txt
*new* HEART TESTS REVEAL NO HEIGHTENED RISK AT LONDON METHADONE CLINIC
British guidelines suggest electrocardiogram screening only of patients who might be particularly
vulnerable to a possibly methadone-aggravated heart disorder. But a London clinic found this would
still mean testing most patients (not least because of their cocaine use), with huge resource
implications yet uncertain benefits. When they tried it, no patients tested as being at high risk.
http://findings.org.uk/count/downloads/download.php?file=Mayet_S_4.cab
*new* COCAINE AGGRAVATES ANY METHADONE-RELATED HEART RISK
A US clinic tried routine on-site electrocardiogram screening of all its methadone patients and
found just three at-risk patients in three years. The key finding was that continuing cocaine use
was the factor most clearly associated with potentially adverse changes in heart function,
confirming this as a risk factor which might justify screening large numbers of patients.
http://findings.org.uk/count/downloads/download.php?file=Fareed_A_3.cab
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alert you to site updates and recent UK-relevant evaluation studies and reviews of drug/alcohol
interventions. Findings is managed by DrugScope, Alcohol Concern and the National Addiction Centre.
The Effectiveness Bank is supported by Alcohol Research UK and the J Paul Getty Jr Charitable Trust.
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