The prescription of methadone for opiate dependence in Australia, 1985-1991

Trends in licit opioid use in Australia, 1984-1998: comparative analysis of international and jurisdictional data

OBJECTIVES

To examine trends from 1984 to 1998 in licit opioids used in Australia compared with nine other developed countries, and in New South Wales compared with other Australian jurisdictions.

DESIGN

Poisson regression analysis of annual rates of national and jurisdictional consumption of methadone, morphine and pethidine.

MAIN OUTCOME MEASURES

All drug data were standardised to defined daily doses per 1000 population per day.

RESULTS

Methadone consumption increased by, on average, 12% per year (RR, 1.12; 95% CI, 1.08-1.17), with Australia in the first rank of countries. Morphine use increased by 5% per year (RR, 1.05; 95% CI, 1.02-1.09), with Australia ranking equal second with three other countries behind Denmark. Consumption of pethidine in all 10 countries was unchanged (RR, 0.99; 95% CI, 0.97-1.00), with Australia equal first. In Australia, use of methadone syrup increased by 17% per year (RR, 1.17; 95% CI, 1.16-1.17) and by 11% per year for methadone tablets (RR, 1.11; 95% CI, 1.10-1.12). Consumption of methadone syrup in NSW was more than double that of any other jurisdiction. Consumption of methadone tablets was 2.4 times higher in South Australia (RR, 2.35; 95% CI, 2.09-2.65) than NSW. The Northern Territory, Tasmania and Queensland also had significantly higher consumption than NSW. From 1991 to 1998, controlled-release morphine consumption increased by 27% per year nationally (RR, 1.27; 95% CI, 1.24-1.30). The NT had 2.6 times more supply of morphine (RR, 2.63; 95% CI, 1.71-4.03) and Tasmania 58% more supply than NSW (RR, 1.58; 95% CI, 1.11-2.25).

CONCLUSIONS

Australia's consumption of licit opioids ranked high internationally. There were diverse trends in the supply of licit opioids to Australia's jurisdictions, resulting in a heterogeneous pattern throughout the country.

Fluvoxamine-methadone interaction

OBJECTIVE

The aim of this paper is to report a case of symptomatic methadone toxicity associated with fluvoxamine treatment.

CLINICAL PICTURE

A 28-year-old woman was admitted to hospital with severe hypoxaemia and hypercapnia indicating hypoventilation. Medication prior to admission had been stable and included methadone 70 mg daily and diazepam 2 mg twice daily. Three weeks before admission she had commenced treatment with fluvoxamine.

TREATMENT

Methadone was decreased to 50 mg daily and diazepam was tapered to zero.

OUTCOME

The serum methadone concentration decreased and oxygenation improved considerably.

CONCLUSIONS

Clinicians should be aware of the potential for a significant drug interaction between fluvoxamine and methadone.

Correlates of retention on the South Australian Methadone Program 1981-91

OBJECTIVES

To investigate correlates of retention on the South Australian Methadone Program during 1981-91.

DESIGN

Retrospective study of a nonstratified random sample of 229 HIV-negative clients who received methadone between January 1981 and June 1991. Data were collected from clinical records of the 229 HIV-negative clients and also from the 40 clients known to be infected with HIV during the decade.

RESULTS

Being HIV positive, receiving larger maximum doses of methadone, receiving methadone from a private pharmacy and enrolling later in the decade were all associated with longer retention times on the program.

CONCLUSIONS

This study supports the findings of previous studies, that maximum dose of methadone is crucial to retention in methadone programs, But even allowing for maximum dose, obtaining methadone from a private pharmacy was also strongly associated with retention on the program. The more 'humane' clinic policy later in the decade is likely to have increased retention and reduced illicit drug use also.

Another wall that crumbled--methadone maintenance treatment in Germany

During the past quarter-century there have been innumerable reports throughout the world documenting the effectiveness of methadone maintenance treatment. None have been as consistently positive as those from Germany, where just a few years ago methadone was effectively banned. The German accomplishments in the past 6 years in treating addicts with methadone confirm the experience elsewhere: Methadone treatment is a highly desired alternative to many who wish to escape the life of the street addict; it is very effective in benefiting the individual patient as well as the general community; and it can be expanded rapidly and on a large scale. What is needed today is not further discussion but a firm commitment to make treatment available on request to every addict willing to accept it. With methadone maintenance--one treatment approach among many--this goal is achievable. There is no justification for settling for less.