Madam, - The decision by 140 pharmacists to withdraw from the methadone protocol scheme is deeply worrying. Targeting a socially excluded, highly vulnerable group is unwarrantable. A pharmacist's description of methadone users as "younger, more mobile and resourceful" than the elderly and infirm is at best inaccurate and would not in any case justify the proposed action.
The American Society of Addiction Medicine states that "discontinuation of methadone maintenance carries substantial risk associated with relapse to intravenous drug use. Discontinuation of methadone maintenance should be attempted only when strongly desired by the rehabilitated patient, and conducted with adequate supervision and support".
Relapse to intravenous drug use is associated with a high risk of overdose. A significant loss of tolerance to opioids can occur within as little as three days without methadone. Abrupt withdrawal of methadone in a pregnant woman can cause death of the foetus. Lack of access may result in patients leaving methadone programmes. Re-entry to a programme re-exposes patients to the period of highest risk for in-treatment mortality, widely recognised as the first two weeks. - Yours, etc,
Dr SINÉAD DONOHUE, Islandbridge, Dublin 8.
Madam, - As a community pharmacist I find it ironic that the HSE is warning of "significant public order incidents" arising from its new methadone dispensing arrangements ( The Irish Times, October 13th). The HSE intends to hire extra security staff at it its clinics to counter this threat. The danger is apparently posed by those patients who have been dispensed methadone in community pharmacies over the past decade.
In all that time the Department of Health and the HSE refused to acknowledge the level of risk to pharmacy staff. The HSE's sudden recognition of the problem is welcome. Unfortunately it has come only after I and others like me decided that the risk could no longer be justified. - Is mise,
SEAMUS O'MORDHA, Templeogue, Dublin 6W.
Madam, - The action by the Irish Pharmaceutical Union (IPU) in declining methadone cover to addicts is yet another example of an impoverishment of attitudes towards those in need of help. It also damages the collective sense of responsibility that those who work in the caring professions feel towards those in their care.
Addicts in Ireland are both the most despised and most vulnerable group of people in need of assistance from society. That the IPU should use its methadone clients as leverage in a dispute with the Minister for Health is a contemptible acknowledgement of this implicit disdain. - Yours, etc,
FINIAN FALLON, Newmarket Square, Wards Hill, Dublin 8.