Plan to provide alternative to methadone for heroin addicts

Health authorities are seeking funding for the roll-out of an alternative to methadone for treating people with heroin and other opiate drug addictions.

Clinicians and patient groups have long been critical of the absence of an alternative to methadone, given that a majority of patients do not move on from the treatment.

More than 10,000 people received methadone last year as a treatment for drug addiction. Some 3,300 have been in receipt of the drug for a decade or more.

A number of Health Service Executive and Department of Health expert group reports have called over recent years for wider access to Suboxone as an alternative to methadone.

The drug is produced as a tablet, taken under the tongue and used as a treatment for patients with dependence on opioid drugs such as heroin, morphine and codeine. It contains two active ingredients, buprenorphine – which reduces symptoms of dependency on opioid drugs – and naloxone, which guards against overdose through misuse.

One-size-fits-all approach

Dr Ide Delargy, a member of the HSE’s implementation group for the drug, said it was time the country moved on from a “one-size-fits-all” approach to opioid addiction. “I don’t think people would accept a situation in, say, heart disease that just one drugs is available,” say Dr Delargy,

Ireland is one of four European Union member states where Suboxone is not available as an alternative to methadone. It typically accounts for between 20 and 30 per cent of the "market" in other European countries.

A Department of Health expert group has recommended the drug be made available, on a limited basis, for certain patients such as young addicts who have never been on methadone and who hope to detox.

It is also recommended for patients with an addiction to codeine as well as patients on methadone who have shown signs of living in a stable manner for at least six months.

A key obstacle has been the price of the drug. By some estimates it is several times cost of methadone, although generic equivalents are increasingly available on the market.

Tony Geoghegan, chief executive of Merchant's Quay Ireland, a homeless and drugs service, has also supported the availability of an alternative treatment for opioid addiction.

While methadone has helped save and stabilise lives, he said the numbers moving beyond it are disappointing.

Detoxification beds

This is due partly to the fact that not enough resources are going into supporting people to move beyond the drug. While there were more than 10,000 people on methadone, he said there were only about 40 beds where individuals were able to detox under good supervision.

A spokesperson for the HSE was unavailable for comment yesterday, but the executive is understood to have signalled its intention to reimburse Suboxone for certain patients in the public health services.

The drug has been used on a pilot basis and in certain clinics in recent years, but it is not widely available. If funding is made available for the drug, it is likely to be made available on a wider basis over the coming months.

A spokesman for Indivor, the manufacturers of the drug, declined to comment on the basis that the issue was still under discussion among health authorities.

If it gets the go-ahead, the drug is likely to subject to strict conditions and would not be available for patients who have yet to stabilise on methadone and who have a history of failing to comply with treatment regimes.