Any doctors on? Need help re Codeine addiction, 900mg daily.

[deeplyworried]

Can anyone help - my xp has confessed this is what he is taking. What are the physical / mental effects likely to be? He says he is suicidal. How can I help him?

If he has been having the dose of codeine as nurofen plus/cuprofen plus/co-codomol/solpadeine plus/paramol then is is very very important he gets liver function tests done, also kidney function tests should be done as well as a precaution but are not a major concern. He may have seriously damaged his liver though.

900mg of codeine is equivalent to about 13mg of methadone. I have heard of methadone being used in a community pharmacy setting for someone who was addicted to dihydrocodeine but it was done as a rapid detox.

Drug Addiction services is the best for him to see, they will also look into his depression if he mentions this to his key worker.

60mg of dihydrocodeine daily is not a high dose.

I took 240mg pper day for over 6 mths..I cannot imagine how he functions on 900 or how the hell he gets it down him
he must seek help

I am a doctor in drugs work and would certainly manage this man with methadone/subutex with a preference for subutex. Risk of overdose is managed by a supervised consumption regime
the first thing is to treat the physical addiction then by means of keyworking plus referral to mental health services if appropriate manage the other issues

it's achievable and I have had good results

good luck

I;ve been a drugs worker for 5 years and have never heard of this.

That said I work in an area with a popualtion of 700,000 people and we have 11 NHS beds for alcohol detox, drug detox takes priority. We have to practically beg doctors to do a home detox for alcohol with librium and most don't want to know about any other substance dependancy.

It surprises me that Mathadone is also being used for Codeine addiction considering its dubious success rate with Heroin users.

What are the long term success rate stats?

And Pysciatric care here is laughable, wait at least 4 - 6 mnths for an appt and then get seen once a month? That, IMHO is not "care".

Curious opinion for a drugs worker Ladyanonymous.

I am also a drugs worker, and agree with MissMoopy and handmedownqueen

Methadone only works for a few patients. For the vast majority it doesn't work, I see far more patients with doses increasing over time rather than decreasing. If I was being very generous I would estimate that about 3% of methadone patients i have seen have had the program work for them to the extent that they could hold down a job.

The only way methadone "works" is maybe to reduce criminal behaviour on average but that is it.

I do not know what the solution is addicts but, methadone does not appear to me (from peer reviewed research studies) to be the solution.

I have seen both Subutex and Methadone used successfully in OTC dependency clients. Both are physically less damaging by far, and he will get support alongside any prescribing.
I agree with whoever advised LFT's, and I would expect a good service to do this as a matter of course in this instance.
Impatient detox is also an option but if he is struggling with his mood this might be too rapid and too risky. I hope he gets the help he needs. You might want to look for family/carers support groups in your area too for more support x

Crosswhy - I think your 3% figure was clearly plucked from thin air!
I would love to know what you base your estimate on. I have worked in prescribing services for over 7 years with the most vulnerable groups and think that statements like that are what will help treatment services become zero tolerance which, in my opinion, will be to the detrimant of our clients.

Addicts is also a value laden, hideous description and one that i would not expect from someone purporting to work in the field.

Thanks everyone - I have him here for dinner tomorrow evening and will try and talk to him about options / avenues for help. As I said he is off to the community treatment lot now, has been referred by the doc so hopefully that should help. Terrifying that they might put him on Methodone?? This is all so far out of my world.

Why a "curious" opinion? Just because we work in the same feild does not mean we all work in the same way or agree with different methods of working and opinions?

MissMoopy, my figure of 3% is a guestimate based on my personal experience in community pharmacies. I know of people who have worked in the same store for over 15 years and have only seen three patients become methadone free (the store in question usually has 20-30 methadone patients at any given time).

Maybe the difference in our experience is where we work. In Scotland 97% of methadone patients were still taking illegal drugs or methadone three years after starting the program whereas in England 25% of patients are methadone free inside two years.

In Scotland, at least, methadone is not the answer, what the answer is I do not know.

deeplyworried Subutex is the most likely option for your man. Much less 'scary'.

Ladyanonymous Curious because of your seeming lack of faith in the service you are involved in providing.

CrossWhy I work in Scotland, and have also worked in England. Measuring the goal of being methadone free is soo missing the point of methadone assisted treatment.

I think I like you stinkypinky!

Thank you everyone - we are in Scotland. Just have to wait and see how it pans out I guess, it is awful not being able to actually DO very much.