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Drugs: Methadone

Volume 800: debated on Monday 28 October 2019


Asked by

To ask Her Majesty’s Government what plans they have to assess the regulation, and the general effectiveness, of methadone.

My Lords, methadone is a cost-effective and evidence-based opioid substitution treatment. The National Institute for Health and Care Excellence has published several pieces of guidance on drug treatment. It recommends opioid substitute treatment with either methadone or buprenorphine, delivered alongside psychosocial treatment, as the front-line treatment for heroin dependency. There are no plans to undertake any further review.

My Lords, I am grateful to the Minister for that reply. I am disappointed that the Government are not prepared to undertake a review. I do not want methadone treatment to end, but I believe that the cost is now becoming astronomical and have sent the Minister questions about this previously. People in the industry say that it now costs £1 billion a year, yet an increasing number of people are dying from methadone and a shortage of resourcing for support and advice. We are going nowhere. They are parked in a cul-de-sac. Should we not take a look at what alternatives may be available, where that kind of money could be put to better use and give people hope, rather than just abandon them?

I thank the noble Lord for his question. He will know that the DHSC does not collect data on the costs of supply of methadone centrally, as he has asked this question. However, I reassure him that Public Health England carried out an evidence review in 2017 on the effectiveness of drug treatment across the UK, which found that our outcomes are as good as or better than those internationally, including on effectiveness and value for money. However, we recognise the challenge of drug deaths and drug treatment across the UK and the challenge to local authorities. There will be an effective review of drugs policy, which will include Carol Black’s review of drugs.

My Lords, what consideration has been given to extending the Swiss model of heroin-assisted treatment, with addicts attending clinics under supervision and injecting safely, given that there is clear evidence of the success of this model in improving the health of addicts and reducing both the number of overdoses and levels of crime?

Heroin-assisted treatment can be an effective way of treating individuals for whom other opioid substitutes have not been effective. It is open to local areas under the existing legal framework, but given that funding decisions on drug and alcohol treatment have been devolved, it is for them to decide whether to commission HAT services based on their assessment of local need.

My Lords, are the Government seriously suggesting that they could be spending £1 billion but do not actually know whether they are?

No, the Government are suggesting that a PHE review in 2017 found that drug and alcohol treatment services are currently as good as or better than international comparators. They are cost-effective and the outcomes are good. However, we recognise that the number of deaths at the moment is too high, which is why the Home Office has commissioned a review of drugs policy by Dame Carol Black, and there will be a summit in Glasgow before the end of the year to find out what more can be done to improve these services.

My Lords, do the Government recognise that methadone, apart from being an opioid substitute, is therapeutically a useful drug because it hits a different set of receptors from many other opioids? Each individual opioid is unique in its pharmacological profile and action, so there are real dangers in labelling methadone as only an opioid substitute. Patients who need it for symptom control can worry that they are stigmatised by being prescribed methadone, and there can be difficulties in supply therapeutically. In addition, any review of addiction and addiction services cannot look only at substituting one drug for another but must also look at the fundamental underlying drivers to the addiction that has occurred. It must give support in the long term, because these people remain at risk of returning to their addictive habits.

The noble Baroness in her question has outlined her expertise in this. She is quite right that the evidence base for the effectiveness of methadone is robust. It is provided for by NICE guidance and UK drug misuse and dependence treatment guidelines. Those have recently been updated in the Orange Book, which provides clinical guidance to clinicians and was published in 2017. There is also an update coming to NICE guidelines on how to manage drug dependency, which will be published in 2021. Therefore, up-to-date guidance is available for clinicians which ensures that they are able to provide both therapeutic and dependency management to those on prescription but also on withdrawal treatment. I therefore reassure the House that this is being taken extremely seriously by the Department of Health and Social Care, and by all related departments.

My Lords, how can my noble friend say that it represents value for money if she does not know the cost? To go back to the question of the noble Lord, Lord Brooke, surely that cost has to be taken as an opportunity cost compared to other forms of treatment that do not continue with people being dependent on drugs.

My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.

My Lords, the lack of local government funding for drug treatment, combined with a policy-driven emphasis on abstinence rather than harm reduction, has frequently been cited as a likely reason for the increased number of drug-related deaths. In 2016, the Advisory Council on the Misuse of Drugs advised the Government on how to reduce opioid-related deaths in the UK. Despite Ministers claiming to accept the recommendations made by the ACMD, funding for drug treatment services, including OST—opioid substitution therapy—has been cut across the UK. Can the Minister confirm that this is the case and explain why the Government are not following the advice of the ACMD?

We have accepted the recommendations of the ACMD and are very grateful for its advice, which is evidence-based and recommends the use of methadone. However, we recognise that services are under pressure and face a range of challenges, including the ageing cohort of drug users, which we believe is related to the increase in deaths. We are reassured by the 2017 PHE review, which, as I said, found outcomes that are as good as, or better than, international comparators, which shows that local authorities are delivering effectively even under that pressure. I am pleased, therefore, that the public health grant remains ring-fenced and will now increase in real terms. We will be focusing on how that can assist drug and alcohol services so that we can see them improve locally. This will be a particular focus for the Drug Recovery Champion, who will have an annual delivery plan and will be working with communities to improve the services available.