Scottish heroin addicts denied safer substitute

Use of Suboxone has led to fewer deaths. Picture: Getty
Use of Suboxone has led to fewer deaths. Picture: Getty
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DOCTORS in Scotland are being prevented from prescribing a heroin alternative proven to be significantly safer than methadone because of a squeeze on health budgets, experts have warned.

Suboxone has been adopted by a growing number of countries including Denmark, Norway and France which have seen a substantial dip in the number of drug deaths.

Professor Neil McKeganey, director of the Centre for Drug Misuse Research (CDMR), said the higher price meant GPs are being put off issuing it.

Scotland spends about 
£36 million per year or £100,000 per day on methadone with 26,200 users visiting their GP in 2012/13.

The cost of an eight-month programme of methadone, given as a liquid, is £1,491 per patient, compared with £1,981 per patient for Suboxone, a tablet, over the same period.

Overdose-related deaths in Scotland have climbed from 244 in 1996 to 581 in 2012. Methadone was implicated as the cause of 237 deaths.

McKeganey said many methadone deaths were caused by users “topping-up” their dose with street heroin.

Suboxone avoids this as any attempt to combine it with heroin puts the user into withdrawal, he said.

McKeganey said: “In Scotland, apart from a small reduction in most recent totals, we have seen continuously high levels of drug use mortality.

“Yet Scottish doctors have been strangely reluctant to move their prescribing away from methadone on to Suboxone.

“The drug is more expensive, so it could be that they are being driven by concerns about price. But if it were to result in a major reduction in the number of addict deaths, many people would say that’s a price worth paying.”

He said a comparative study the CDMR is carrying out has shown that drug addicts on Suboxone were “much more likely” to have a prolonged period off heroin.

He also said that he felt many of the organisations who represented drug users’ rights had been “completely mute” on the prescribing of methadone, preferring to “leave it up to the doctor to decide what’s best for the drug using patient – even though the evidence is ample now that this other drug may be preferable for the treatment of heroin addiction”.

Dave Liddell, director of the Scottish Drugs Forum, said he recognised there has been little use of Suboxone, but did not accept that drug groups had been silent on the issue.

“We’ve always argued for choice in substitute prescribing, including looking at heroin assisted treatments for those who can’t engage [in other ones].”

Dr Richard Watson, a Glasgow GP with around 100 patients receiving either methadone or Suboxone, told Scotland on Sunday: “It may be that Suboxone should be more widely prescribed.

“Certainly, we must encourage more funding for enhanced services for treatment of drug misuse in all areas of Scotland.”