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methadone ) at the time of death .
With more than 100,000 people accessing OST on a daily basis , this still represents ‘ a very significant comm - unity ’ who are working to ‘ stay compliant ’ ( or not get caught if they ’ re not ) within prescribing and dispensing regimes . Concern about misuse has seen the pharma - ceutical industry introduce medicines with ‘ abuse deterrents ’ added ( naloxone ’ s addition to buprenor - phine , for example ) ostensibly to prevent their injection or reduce the chances of diversion . Urine screening takes place routinely to corroborate what the client is saying . Malloy is disturbed that ‘ recovery workers who ’ ve been through treatment programmes them - selves are now being coached to catch someone else ’.
Even The language around OST is negative , he points out – ‘ nobody likes you going to the chemist for that ’, or ‘ you ’ re not in recovery ’. This , coupled with the broader stigma attached to OST , ‘ doesn ’ t frame drug treatment as a particularly attractive prospect , when everything around it is about squeezing you out of it .’
With the pharmaceutical industry racing to develop forms of OST – such as fast-dissolving buprenorphine products , which offer additional benefits to clients and healthcare professionals , and which are easier to dispense , supervise and consume – he believes it ’ s never been more important to understand what ’ s driving each new development : ‘ Is it about patient acceptability , clinical effectiveness , cost effectiveness , or systems compliance ?’ Alongside current and new forms of oral ( sublingual or on the tongue ) buprenorphine we are familiar with , we may see longer acting formulations – implanted pellettype formulations and depot injections .
‘ For the person whose life depends on it , the situation could not be more crucial and requires a fundamental shake-up in the way we view and engage people who use drugs , those receiving OST medicines , service users and patients ,’ says Malloy .
He throws a challenge to the treatment sector : ‘ charities and commissioned services must have on their governing board representatives from the population they ’ re seeking to treat and support . At the moment we might hear , “ we consulted with service users ” – but they don ’ t actually empower them to be involved in the decision-making . You ’ re back to a rather paternalistic approach of “ here ’ s what we ’ ll do for you ”.’
Further to this , ‘ the pharma and regulatory industry has to make greater efforts to engage the patient population ,’ he says . A way forward could be through community advisory boards for OST patients and drug users to learn about the regulatory machinery for newly developed drugs .
‘ We have to start having this conversation ,’ says Malloy . ‘ Because the market is changing – and if we don ’ t respond to some of these changes , they will be imposed on us . We ’ ll find ourselves with options that very few people will properly understand or have been consulted on .’
This article has been produced with support from Martindale Pharma , which has not influenced the content in any way .
‘ Charities and commissioned services must have on their governing board representatives from the population they ’ re seeking to treat and support .’ Stephen Malloy
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