National survey of methadone prescribing for maintenance treatment: 'Opiophobia' among substance misuse services?

Abstract

Aims and method: The aims of this study were to describe the characteristics of substance misuse services prescribing methadone for maintenance treatment of opioid dependence and to determine the average daily doses of methadone prescribed across England. A postal questionnaire survey of all substance misuse treatment centres in England was carried out. Results: A total of 298 treatment centres were identified and contacted, 212 of which responded to the survey (response rate of 71%). Of these, 157 were prescribing methadone for maintenance treatment; the majority (71%) were community-based and 125 centres had doctors attached. The most common formulation of methadone prescription was oral methadone mixture (152 centres, 97%). The mean daily dose of methadone prescribed was 47 mg. Surprisingly, 37 (24%) of the respondents felt that methadone maintenance treatment should be time-limited and 21 teams (13%) stated that patients should receive only drug substitution and no psychosocial interventions. Clinical implications: There is currently a move among substance misuse services towards community-based treatment. In our survey, the mean daily dose of methadone prescribed was less than the dosage recommended by the Department of Health. This suggests that specialist addiction services are continuing to underprescribe heroin substitutes. The inadequate understanding of some of the respondents of the basic principles of methadone maintenance treatment also raises concerns, and highlights the need for further training and education.