Dear all
Please could anyone tell me if there is any contraindication to this practice.
It hardly seems like Best Practice to me instnctively but is/are there any clinical guidelines to either stop this practice or put my mind at rest that it is fine to do this to a huge cohort of clients.
Ppl are being given Rosemont s/vised consumption all week and then come the weekend they all have to have Physeptone.
When i enquired i was told it all contractual so in my mind that is a financial driver not a clinical one.
Any suggestions comments/fears/words of hope.
I went ahead blindly defending the service but when push came to shove i found out i was wrong.
Best
Tony B

Its the same drug, so a pharmacy can dispense what they like unless a brand name is specified. You are confusing brand names and drug companies here. Rosemont is a pharmaceutical company that makes generic methadone and Methadose, the 10mg/ml combination. Physeptone is the brand name for methadone produced by Martindale Pharmaceuticals, coming in mixture, tablets and ampoules. Could you be a bit more specific about what you are saying. Using different manufaturers is not bad practice if it is the same product.

This message has been edited. Last edited by: Jim Barnard,

Sorry Jim but i am not confused at all and i think it is perfectly clear what i am saying or asking advice on.
I am pretty much aware of who is who in the Pharmaceutical world and having reread my post i am ......well lets leave it at that.
Best
Tony

Sorry Tony, I was not wanting to be funny about this, I was genuinely confused. I presume, in that case, that you are referring to swapping from martindale, to Rosemont methadone mixture 1mg/ml. This seems wierd as I don't think there is much of a price difference. However I don't think it could be seen as bad practice as it is the same product (in theory).

Thats fine Jim im having a day from Hell at present...Kids and its not even half term.
No what i am referring to is that during the week clients are given Methadone 1mg/ml SF under supervised consumption at the (ATU)and at weekends the Pharmacists are giving them Physeptone 1/1 SF.
I suppose what i am saying is that the arguement to switch to Physeptone was put across very strongly along the lines of 'its better', 'no additives' etc etc.
But when it comes to the weekend its okay.
I do know, as i said, the history around Physeptone/Methadone branding.
I just cannot accept 'fudging' of issues and as this, from what i can discover is purely A contract/finance motive/reason.
I know its the same drug but i really do not understand this. What about continuity. I have been shown too much to the contrary now to allow this to 'slide' and accept that clients are not noticing and who knows even suffering.
I don't know if its a placebo or additives here but there is a problem.
I should have been a little clearer Jim you are correct as usual( are you fed up with being right yet
thanks tho Jim at least you always engage with me.
Best
Tony B

Hi Tony

I must admit I'm completely confused by your post;are you saying that people are experiencing withdrawals at the weekend on physeptone? I was in hospital recently and was given methadone mixture, at home I take physeptone tablets; I didn't notice any difference. I do know what a placebo is but cannot believe that you're saying people may be given a placebo at the weekends; please explain.

Best as always.

B x

Beryl all i am doing is relaying what i am given by the S/u grp in my area.
I do not mean ppl are given placebo and im sorry if it came across that way, what i meant was that the effects or w/drawals are placebo i.e. not relly happening or a perception rather than a fact. nThat was how our consultant described it at the clinical Board.
It just seems to me that if you are on one 'brand' because this brand has been 'pushed' on you thru a provider countywide for supposed health reasons, as i said no additives etc then you should preferably remain on that same brand. I am sure this makes sense somewhere to someone.
I know it doesn't to me but i am being told these clients are suffering or not being 'held' by the Physeptone at w/ends after being given the other all week under scc at the clinic.
When i explain its the same drug it really isn't helping if i just keep repeating myself and they are still having these problems.
I am not going to tell them they are indeed not having any problems.
What i did do was promise to attempt to find out if there is any reason for this.
I am going to read this one twenty times before i press send.
Very Best
Tony B

Thanks for the explanation Tony. Like you, I don't really understand what it's all about but it probably does make sense to somebody.How do they differentiate between what they get during the week and the weekend? The label will obviously be on the take home dose but not on what is dispensed during the week; is it that the taste is different.I must admit, I'm still confused but I'll leave it at that.

Best
B x

Beryl thanks a lot mate
I think you have just inadvertantly hit the nail on the head.
How are they differentiating between the two, without the information???
Is it the taste, well it seems to be the efficiency....they tell me.
Intereting as they would not know. Only by experience.
Or is someone pushing for research/info and adding 2+2 and coming up with a servise user satisfaction survey of their own.
As i said at the beginning of the thread i am playing Devils Advocate in a sense as i am relaying the 'experiences' third hand.
Best
Tony B

Hello all

Is the problem/issue that during the week patients are dispensed one particular brand of methadone from the specialist service (under in-house supervised consumption maybe?) but at the weekends are dispensed another brand from the local communty pharmacists?

I can see why this arrangement could promote undesirable medication inconsistencies for patients.
So why not have prescriptions dispensed from community pharmacies generally?
At least there would be consistency of methadone product.

Simon

Hi All, I had a client recently who was dispensed rosemount after there was a shortage of sugar free physeptone in our area. When he got home it was orange in colour and he took the same dose as usual. Started to withdraw, so took the next days dose in the early hours hoping it would work more than the initial dose. Still withdrawing the next day, came to me explained situ, I contacted pharmacy and they explained the shortage issue and offerd to change to the green one as they now had stock. The client was convinced the rose' was not methadone, I eventually ruled out psychological i.e looked different thus didn't work in his head. I changed his px and he was extremely grateful that i believed him, which I thought was sad because I was asked by other prof's "how do you know he's withdrawing? does he have objective signs?" To me, he was suffering, why blag that? Why blag meth isn't working to only get more meth? I know these are side issues from the discussion, but I can understand why clients get upset by things like this... but legally, as long as it's the same strength/dose e.g 1mg/1ml the manfacturer maybe personal preference... after all we have choice in other things e.g bread, coffee
p.s hope things ease soon Tony, you read stressed out mate, take care fella

The orange/ metadone is the linctus which is 2mgs/5mls or 40% the strength of the green which is the mixture, no wonder he was withdrawing.

Beryl

quote:

Originally posted by Beryl:
The orange/ metadone is the linctus which is 2mgs/5mls or 40% the strength of the green which is the mixture, no wonder he was withdrawing.

Beryl

I do hope I haven't got this wrong and apologise if I have.

Hi Beryl, the strength was 1 in 1 but it's the mucky brown colour, not the vivid orange you see on drug posters.... I think that's the slightly concentrated one.. I spoke to the hospital pharmacist and he couldn't clarify the issue other than to suggest sending it for analysis... the block here was who would pay? Sad I know but that's the harsh reality for health today I guess.

Joe

After I'd posted I read your profile, hence the apologetic backpedalling.

Beryl

I'm not saying that it is the case here but, patients do get upset when the product they are used to is changed. I'm not just talking about Methadone. Patients get used to a particular product and find someone switches them to a generic. Some patients do get upset by this, the name can be different, the shape, the package. I think some of it is marketing with flash boxes from the branded product with the pretty coloured pills and then the white box and plain generic pills.
I think we have discussed in the past people switching to sugar free Methadone and have thought it was watered down or not as effective as it is thinner in viscosity. I think Bob Dunkley mentionned in the past he'd been accused of watering it down (Where is Bob ?)
There is a lot of influence from the drug companies and colour and taste of a product or design of a box can mean a lot to patients.

Simon thanks for that mate.
I was talking to the S/U coordinator who first brought this to me yesterday and his ans to my plea for evidence of symptoms was ' Well i can't give you that at present but Tone if you think of Coffee and you are used to drinking a filter roast good coffee or even 'Appy Shipper' then when changed you say i'm not having that its not the same'.
Simon i think both he and you have a point here and still backs my case for continuity of Care or perceptions of.
Interestingly i do find it very strange when one particular 'brand', or not, is hyped to the point that it is to be piloted as the new 'Wunderdrug' but then due to 'contractual' reasons this 'pilot' is only, in reality, 2 days out of 7. If its that much better for the clients(as it was 'sold' to the caregroup and S/Us as) then how can you only give this to them 2days a week?
Honestly if you were amongst it locally and knew the history then i am sorry i defy anyone to find this anything but bizarre. Famous last words.
Best
Tony B
pS i was hoping for more from our Pharmacist colleagues on this one.......please. TB
pps I please already know that the active ingredient is indeed the same but the more i try to tell the S/Us that the more they think i do not understand them, which is weird as i was dependent for 24 years.

Simon M
Thanks too and also for your 'support' for the continuity. It does make sense surely?
Best
Tony B

The comparison to coffee is a good one. We all have differing tastes. One person may like Happy shopper instant garbage another may only like the most expensive ground coffee despite it having the exact same amount of caffeine in (If that was the case).
The Methadone in Methadone is exactly that. The other stuff added may make it less palatable or less desirable or just different. The presentation does make a difference.
I remember many years ago a Doctor at a prison I worked in prescribing Benerva a vitamin B. They were told by the Doctor it was a sleeping tablet. The prisoners came back asking for more praising the effectiveness. I'm sure it had a good price on the excercise yard.