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GPs receive over €14.8 million in fees from methadone prescribing in two years

Under the HSE methadone treatment service, payments in consultation fees to GMS doctors in 2015 totalled €7,545,016, and €7,268,803 in 2014. Payments to pharmacies amounted to €13,111,090 in 2015 and €12,696,107 in 2014 and included the ingredient cost, dispensing fees and patient care fees.

There were 10,043 people engaged in HSE methadone treatment services as of April last, up from 9,852 the previous year.

Some 5,768 people in Ireland have been on methadone treatment for over five years and 3,640 for over 10 years, as of December 2015.

There are an estimated 787 residential beds in residential addiction services (including private provision), according to the most recently-available figures. This comprises 23 inpatient unit detoxification beds, 117 community-based residential detoxification beds, four adolescent residential detoxification beds, 625 residential rehabilitation beds and 18 adolescent residential rehabilitation beds.

In 2014, some politicians and addiction workers in the UK called for the introduction of a blanket time-limit on prescribing methadone. This was rejected by the UK Advisory Council on the Misuse of Drugs.

GP and addictions specialist Dr Garrett McGovern told MI the evidence supports the efficacy of methadone treatment across various quality-of-life indicators. While he said he was not against detox and some patients could do well, he maintained the outcomes “aren’t great” internationally in this regard.

“I read an awful lot about ‘long-term parked on methadone’ and ‘liquid handcuffs’ — none of it is faithful to the evidence and that is the problem,” said Dr McGovern. “The evidence says that the longer you are on this treatment, the better you do. I don’t see anybody talking about the length of treatment where people are on warfarin or cardiac medication.”

Dr Patrick Troy, another GP working in the addiction field, said detoxification only worked in a small number of cases. It could place people “in great danger because their tolerance to opioids goes down, and of course if they dabble again, they believe they have the same tolerance”.

He said he was aware of two deaths in the last two years where people “desired to ‘come down’ off methadone”.

See news feature, p12-14

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