Administration of a lighter-coloured methadone liquid. Byrne A, Hallinan R, Love A. D&A Review [letter] 2002 21;4:405
We report a naturalistic experiment whereby 88 dependent patients were administered a lighter coloured methadone preparation for 2 weeks with unexpected outcomes.
The methadone liquid was supplied as new batch which was much lighter in colour than usual. Its appearance was consistent with a 1:1 dilution with water. Being a pure solution, free of sugars, flavouring or preservatives, the taste was reported to be not substantially different although some patients felt it was less bitter.
In this medical practice, over a 2 week period, 88 patients were given 1200 doses of the lighter coloured medicine. Of these, 686 were 'take-away' or dispensed doses (56%, mean 3.9 doses per patient per week). Patients had been in treatment an average of 6.3 years and 69 (78%) had consistently clear supervised urine tests for heroin, cocaine and amphetamine. There were 11 who were also prescribed supervised diazepam due to dual dependency.
Approximately 30 of the patients reported withdrawal symptoms from the medicine and two made telephoned reports to the NSW Methadone Advice and Complaint Service. Symptoms included insomnia, cravings, sweating and 'hanging out'. No patient reported using heroin as a result of the new medication but several requested a return to the previous (darker) medicine or the alternative sugar-based syrup, each of which was still available individually on request. One patient became acutely agitated over the change and ultimately moved to another dispensary.
The strength of methadone in both samples was found to be identical on pathology testing. On request, the drug company restored the usual supply after two weeks.
These observations would seem to indicate that minor symptoms may be interpreted incorrectly as a lack of opioid. Thus much of what patients experience from small changes in opiate doses may be psychologically mediated. Illicit drug users often report variable strengths of street drugs. In this case, a batch of medicine with less dye in it caused serious and credible complaints from a large proportion of long-term stable patients despite reassurance at the time. In two cases the feelings were so strong that outside assistance was sought over the matter.
Yours faithfully,
*Andrew Byrne (dependency specialist)
*Richard Hallinan (associate general practitioner)
*Anne Love (registered nurse)
*The Medical Practice, 75 Redfern St, Redfern, NSW, 2016
email for correspondence: ajbyrne@ozemail.com.au
Our thanks for Mr David Ruxton of Sydney Diagnostic Services who performed the drug assays.
