Author Topic: Forced methadone over request for subutex  (Read 2635 times)

Karrys

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Forced methadone over request for subutex
« on: December 27, 2013, 07:06:07 PM »
hello I'm knew to this site but have a question that is causing me a lot of concern regarding treatment in the community !
I write as the mother of a son addicted to heroin,
Christmas eve he had appointment with local community drug clinic which in my opinion was the first step toward him wanting to try to recover , he was actually in treatment approx 4 months ago (subtex) administered at boots chemist, however had a problem attending one day and that was the end of that !
this time he went along to the clinic and asked to go back on subtex but after being interviewed by three members of staff was told that he couldn't have subtex only methadone now, he really does not want methadone as he was doing well on subtex and he believes it is harder to withdraw from methadone
He left the centre feeling dejected and we are no further forward, we don't know if he had a choice or is this the system that you get what they want to give
the only thing they said as he left was did he want to attend any therapy in the community !!!

sapphire

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Re: Forced methadone over request for subutex
« Reply #1 on: December 28, 2013, 02:01:20 PM »
It could be, that if when your son was on Subutex last time, that he really didn't do as well as they had hoped, and perhaps he still used on top of the Subutex? I don't know obviously, I am just surmising reasons that they would recommend methadone over Subutex.

Hi Karrys, and welcome to the Alliance!

If your son was continuing to give urine analysis' that were positive for either illegal or un-prescribed drugs, then the drug service would see that as a sign that Subutex was not really working for him.

Do you know why he missed his pickup that time? It could also be that there is more to this than he is willing to admit to you?

Anyway, methadone really is no harder to come off than Subutex. When Subutex was new it was put about by the pharmaceutical companies that it was easier to detox from than methadone, but that simply is not true.

As long as you so a slow taper, dropping in small increments of whatever substance you are prescribed, it is possible to keep any withdrawal symptoms to a minimum.

At the moment, would it not be better for your son to concentrate on his recovery, rather than worrying about what will happen when he gets to the detox stage, as that it likely to be a long way away.

The minimum recommended time in treatment is 2 years, so that is a long way off yet.

So, the drug service may think they are acting in your son's best interests to advise that he start on methadone instead of Subutex. Do you know what reasons they gave him when they said that they thought he would be better on a methadone script than Subutex?

Having said all that though, if your son really does not want to start on methadone, his wishes should be taken into consideration by his drug service. They cannot force any particular treatment upon a person, and it says in the guidelines that they are supposed to follow that treatment that the patient is not in favour of is not recommended.

If, after taking all the above into consideration, and that the drug service could (I don't really know enough about the situation to say whether the drug service are correct in what they are recommending) have legitimate reasons for suggesting that your son be better off on methadone, we could intervene for you and speak to the drug service on your behalf.

Of course we would need your son's consent etc to do that, but it is perhaps something you could discuss with him?

Karrys

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Re: Forced methadone over request for subutex
« Reply #2 on: December 31, 2013, 01:06:57 PM »

Thank you for your reply I would like to point out that while my son was on subtex it was only for a short while 6 weeks (approx) and in that time I accompanied him on all clinic appointments and he never had a urine test in between his scripts being issued by the nurse prescriber
The nurse only asked him if he was clean and then provided another script, she said he would be in and out of treatment in 8 weeks at the rate the medication was being reduced.
I've been thinking about methadone vs subtex and understand that it would at least be a step in a direction hopefully away from and controlling heroin use but he is against it and felt that subtex was good for him.
he was refused medication at boots because the script had run out and it was a weekend and clinic was not open to get a repeat script
thank you for your offer to speak with the team at the clinic I will speak with my son and ask him if he would like yountonhelp with this situation
 my heart is aching for him he absolutely wants to try to recover but felt so let down on his last visit and undermined by the staff , we just felt helpless at that stage hopefully we can help things to progress in the near future
this is particularly difficult as we lost a son in law to heroin in April this year and can't believe we are all going through this hell again

sapphire

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Re: Forced methadone over request for subutex
« Reply #3 on: December 31, 2013, 01:42:17 PM »
Karrys, I'm so sorry for your loss. It must make your son's situation even more difficult for you.

If the nurse prescriber was not doing any urine analysis when your son was on Subutex the first time, and all they did was ask if he was clean, I am at a loss to know why they would be so insistent on methadone.

It could be the length of time that he has been using heroin, and the amount he is using that are making them think that methadone would be the better alternative.

If a person uses a lot, and has been for a long time, methadone is usually the more successful opioid replacement.

As I said, if you would like us to intervene and speak with your son's DSP if he is adamant that he will only go back into treatment of they give him Subutex.

Please let us know how you get on, and if you need any support or advice, we are here!

Karrys

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Re: Forced methadone over request for subutex
« Reply #4 on: January 08, 2014, 08:30:54 PM »
Thank you for your reply sapphire

This is an update and would like to know what you think about this

Today I went with my son to the community drug clinic where we saw a nurse and another co worker

My Son told them his request and preferred treatment is subtex but once again was told No....and when I questioned this she said it was because methadone is the first line of treatment for heroin addiction
I said this wasn't the case previously when he was prescribed subtex! she said she didn't know why or how he had been given subtex at that time
My son was adamant that he did not want methadone and we said we felt that they were forcing him into accepting methadone
He felt that he did well on suburex and the reason he fell out of treatment was because when he went to collect his medicstion from boots the pharmacist said that the script had not been signed
He made that known to the nurse today and  she questioned why they had not arranged for him to return later when they could have rectified the script problem his answer was that he felt well enough and thought he could at that point manage without and he apparently did for 3 weeks until he started to use again
After much discusion the nurse decided to go and talk to a doctor
The doctor said if my son would have liver function tests done and then return to the clinic to see him on the 20th of this month he would then discuss the possibility of prescribing subutex

We both felt that was a long time to wait , she then said another doctor would be in on Friday but she didn't  feel that he would be as  obliging as the doctor we could see on the 20th ! I said why is that do they not both work to the same guidelines ? To which she shrugged her shoulders ! She said she has wrote in his notes that he does not want methadone and hopefully this doctor will prescribe what he really wants

My son said he would see the doctor  this Friday and hope he agrees with his request for subtex
another thing that the nurse said was that they are more reluctant to give suburex because people are selling their medication on the streets

I asked how this is possible when it is administered in the pharmacy ? Crushed. And then checked by the pharmacist
 she then replied that not all pharmacists follows his way of administering ? Unbelievable !

Hopefully Friday will see my son get the treatment he wants and he can start the road to recovery !

sapphire

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Re: Forced methadone over request for subutex
« Reply #5 on: January 10, 2014, 01:19:03 PM »
Hmm, all sounds a bit weird. Why a different doctor should allow it and one not I have no idea, as they are supposed to be both working from the same set of guidelines!

Has your son ever had any liver problems or alcohol problems? If he has, they may with hold Subutex on those grounds, as it can be harsh on the liver, hence them asking for a liver function test.

I'm not sure either about Subutex being diverted more than methadone. In my experience they are both diverted to some extent, possibly methadone more so.

As your son is receiving a new script though, he will be doing supervised consumption for a whole at least, so that should not even be a concern to them.

Please let me know how you get along, and if they do try to make him accept methadone we will try to sort that out for you.

Just out of interest, if they do say that methadone is the only thing they are going to offer, do you think your son would accept it? I know it might not be what he wants, but it is going to be better than taking illicit substances.

simon

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Re: Forced methadone over request for subutex
« Reply #6 on: January 14, 2014, 10:37:06 AM »
It all sounds rather odd and lacking in ability to follow guidelines which say it's the patients choice page 48 of the orange book, but if there's no preference then to prescribe Methadone as it's cheaper. With generic Buprenorphine around now I don't know if it is more expensive than Methadone anymore.
If someone is forced to accept something they don't want the chances are it's not going to work well, and why don't people know of the guidelines?

seven

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Re: Forced methadone over request for subutex
« Reply #7 on: January 14, 2014, 11:54:21 AM »
Because the doctors keep that quiet.

feefifoe

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Re: Forced methadone over request for subutex
« Reply #8 on: January 15, 2014, 10:39:13 AM »
@Simon people don't know of the Guidelines because they are given as little information as possible.  It was only by coming on here that I learned about my rights and realised what little help I was actually receiving and how appalling the 'help' I was receiving was. Every centre has its own way of delivering treatment and 'agenda' and they rely on ignorance in order for that to be delivered.

Karrys - I do hope your son can get subutex.  It is easier to come off than methadone in my opinion as you can reduce more easily on it and the final jump off is less painful and indeed somewhat easier relatively.  Subutex, however, should not be used for 'maintenance'.  It needs to be seen as a replacement tool in the short term and then reduced off regularly, slowly but within 6 months ideally, but no longer than a year.  Reductions are painless, you don't feel them are can continue on in our life.  However, please ensure that your son has counselling in place, good counselling, which you may need to source yourself if he is not getting from the drugs centre he is attached to, to receive hand in hand with the subutex so that he builds up emotional strength and the tools not to relapse. 

The very best of luck to your son and you. 


sapphire

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Re: Forced methadone over request for subutex
« Reply #9 on: January 18, 2014, 11:46:33 AM »
@Karrys - if they do try to force Subutex onto your son, there are several things that we can do for you, so please don't think that you don't have options. We are here for you to help.

Simon is completely right as well, enforcing a treatment modality onto a patient is unlikely to be successful, and it says in the guidelines that it is not a recommended course of action.

Bottomline

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Re: Forced methadone over request for subutex
« Reply #10 on: November 25, 2014, 07:40:49 AM »
hi, so sorry to hear abot your struggle, it must been hard for you :(