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OICE REAL
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
February 2017 | drinkanddrugsnews | 13