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Scrap the opioid substitution service

I am a locum pharmacist who has worked in pharmacies in various regions of England. In many of the pharmacies I work in, I dispense methadone or buprenorphine to substance misusers and also provide clean needle packs as requested. It is disturbing for me to see drug misusers collect their methadone or buprenorphine doses and also request needles.

Opioid substitution is supposed to help them come out of addiction. Collecting and using needles to abuse more opioid substances defeats the purpose of the substance misuse service. The patients will end up in a vicious cycle where they will continue to abuse the service, which is funded by taxpayers like me. It is a pity we cannot name these patients because of confidentiality issues. Sometimes, these substance misusers may try to hide their methadone or buprenorphine doses (even under a supervised consumption environment), perhaps trying to sell it on. In other words, they are turning the taxpayers’ money into their money.

If the NHS needs to cut funding, the substance misuse service should be the first to go. Rehabilitation should take place in confined areas like prisons because if substance misusers do not treasure this free service, they should pay for the consequences, not the taxpayer. The NHS can reinvest the money saved into, for example, better cancer treatments.

Wai Sin Kung



Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20202303

Readers' comments (8)

  • Robin Conibere

    Wow, I feel a bit concerned for the patients that Wai Sin Kung provides services for as the above opinion seems very out of touch with modern healthcare practice. The aim of opioid substitution services is to try and reduce the harms that this particularly vulnerable group of patients are exposing themselves too. It seems Wai Wai Sin Kung needs reminding of the GPhC Standards of Conduct, Ethics & Performance, the first of which being "Make patients your first concern". The lack of compassion and the harsh judgement in the above letter makes me concerned for Wai Sin Kung suitable it practice.

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  • Prohibition and imprisonment are demonstrably counter productive in managing the social or medical consequences of substance abuse.

    For a much more patient and society focused approach I would suggest reading or watching the following from Dr John Marks, a psychiatrist working in Merseyside in the early 1990s. His talks heavily influenced my opinions of how to manage the harms of addiction.

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  • I was about to write a comment as I was shocked by the tone of this piece. Both Robin and Graham have already provided feedback - thank you for your comments.

    When the new GPhC standards are published there looks to be a need for a greater understanding of empathy in person-centred care amongst some in the profession.

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  • This piece is absolute garbage

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  • some patients will be collecting for other people who they associate with who might not want to collect for themselves. regardless it is much better for people to have their own clean works rather than share.

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  • I am retired now for 10 years but agree with Wai Sin Kung. One of my greatest headaches when offering this service was looking into the mouths of patients to check if consumed then being asked by the next customer after supervising, "why was that person spitting out green liquid into a container on leaving the premises ?" However carefully observations were made they still seemed to be able to fool you !!

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  • I suggest that Wai Sin Kung needs to increase his understanding of the role of opioid substitution therapy if he is involved in providing services to patients receiving treatment. The role of treatment in opioid addiction is to reduce harm - to the patient , their family and the wider population. It is a good use of taxpayers' money.

    As a pharmacist with 25 years of community and 9 years of prison practice, I do not think that prison is the answer. The support provided to detoxify in such a structured environment can often be helpful but doesn't fully address issues such as lifestyle and peer pressure when individuals are released back into the community.

    As William Ewing highlights, effective supervised consumption is important and there are optimal ways of ensuring self-administration.

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  • It is quite disappointing to read this opinion piece. Sure, everyone is entitled to an opinion but many of the arguments put forth are, in my opinion, misinformed and bigoted.

    There have been a number of thoughtful comments already raised, so I will only add a few points which I feel have not been addressed.

    It is not true that "Opioid substitution is supposed to help them come out of addiction". Although reducing doses and coming 'clean' may be a goal, substitution is just that, a harm minimisation strategy substituting short acting opioids for longer acting methadone or buprenorphine. The aim of most schemes I have been involved in are to bring stability to patients' lives so that they are better able to address social and mental health issues while also ensuring regular contact with social and healthcare professionals. This provides a bit of a safety net to people who may not often engage with healthcare professionals and has the added benefit of reducing high risk behaviours, wider societal damage and crime.

    And economically this is an NHS service worth sustaining. There have been many cost-benefit analyses of substance misuse programs and although they may vary in the degree of economic benefit, all have shown cost savings in health outcomes for patients, reductions in the spread of infectious diseases and savings from reduced crime, court and policing costs.

    This patient group can certainly be challenging to work with as they often lead chaotic lifestyles and have complex social and mental health issues. However, they have definite health needs and can be very professionally rewarding to work with.

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