Drug Misuse

– Scottish Parliament written question – answered on 1st April 2010.

Alert me about debates like this

Photo of Richard Baker Richard Baker Labour

Question S3W-31787

To ask the Scottish Executive what the costs were of supervised dispensing of methadone by community pharmacists in each NHS board area in each of the last five years, broken down by (a) gross ingredient cost, (b) fees for dispensing and (c) fees for supervision.

Photo of Fergus Ewing Fergus Ewing Scottish National Party

In considering costs of supervised dispensing of methadone, it is important to note that the Gross Ingredient Cost (GIC) of 500mls of methadone changed from £7.59 in April 2006, £7.37 in April 2007, with a large increase to £9.54 in April 2008. These price changes mean that care must be taken when considering the cost data provided over time (2004-05 to 2008-09).

In addition to this, variations in the fees for methadone dispensing and supervision and in the manner in which methadone information is collected and reported mean that we do not have complete coverage across Scotland and cannot compare data across time.

The methadone dispensing fee is a payment that covers the actual act of dispensing the Methadone Oral Solution. This is a multi-stage process that starts with unequivocal identification of the patient and confirmation that the prescription meets the legal requirement. The main process would include measuring the volume required, and placing into a suitable container, labelling the container, handing the finished product to the patient, and at some stage also making the appropriate register entry required for the Schedule 2 Controlled Drug and also annotation of the prescription for the act of dispensing. The fee is paid for each act of dispensing. Methadone dispensing fees are not included in the transitional arrangements for implementation of the new pharmacy contract. The fee can be negotiated locally, and in some boards is in excess of the default payment of 175p (as stated in page 24 of the Scottish Drug Tariff, March 2007) up to £2.65.

The methadone supervision fee is a locally agreed facility, which is not identified specifically in the Scottish Drug Tariff. The fee is paid on the occasion where the contractor hands the methadone to the patient, who administers the medicine in the presence of the contractor. (Methadone is long-acting, and a single dose would give the patient twenty-four hours’ cover.) There may be local standards applied to ensure patient compliance before the fee is claimed to ensure probity of process. The costs to the process may include reuse of the vessel used to measure and administer the methadone, plus a possible place of privacy such that administration does not take place in front of other patients in the pharmacy.

Methadone supervision fees are locally negotiated, and where collected centrally, rates range from £3.10 to £4.06. Any other methadone/supervision fees are not captured centrally. Some NHS boards inform NSS of the fee values in place, and also the number of claims made, and this data can be collected. Other NHS boards prefer to collect the data locally, and this data is not normally shared with NSS. This appears to be a local choice made at board level.

Prior to Road to Recovery, the most recent Scottish Drug Strategy was Tackling Drugs in Scotland: Action in Partnership and can be found at the following link:

http://www.scotland.gov.uk/library/documents-w7/tdis-00.htm.

One of the four pillars was based on treatment and targets included the following:

Increase the number of drug misusers in contact with drug treatment and care services in the community by at least 10% every year

This government’s recovery-focused policy on tackling problem drug use goes further and recognises the importance of providing person-centred care and treatment opportunities that suit individual circumstances and needs (The Road to Recovery, 2008 which can be found at the following link http://www.scotland.gov.uk/Resource/Doc/224480/0060586.pdf).

For those who are addicted, this means that a full range of services must be available to them when they need it so that people can progress to recovery through individually tailored treatment and support.

International evidence shows that methadone works as a treatment for heroin dependence and in the Scottish context it is appropriate for methadone to be used as a treatment for substance misuse.

Reducing Harm and Promoting Recovery, 2007 which can be found at the following link:

http://www.scotland.gov.uk/Resource/Doc/180417/0051271.pdf.

The annual ISD Scotland Drug Misuse Statistics Scotland publication shows that:

In 2008-09, 11,955 new individuals engaged with treatment services – the majority of these individuals (64% or 5,955 individuals) reported heroin use and can be found at the following link:

http://www.drugmisuse.isdscotland.org/publications/09dmss/09dmss-026.htm.

Information from the ISD Drug Treatment Waiting Times Framework for the last four quarters (December 2008 to September 2009) shows a:

19% rise in the number of clients offered a date for any intervention and can be found at the following link http://www.drugmisuse.isdscotland.org/wtpilot/reports_revised_julsep09.pdf.

Regarding treatment types, there is a:

13% rise in the number of clients offered a date for prescribed drug treatment which is lower in relative terms when compared with the

20% rise in the number of clients offered structured preparatory interventions, and

19% rise in the number of clients offered community based support/rehabilitation.

This indicates that a range of treatment interventions are being offered, and in increasing numbers. This would be consistent with the aims of the drugs strategy and would seem consistent with the increased numbers of people being accepted into treatment.

Data on supervised methadone dispensing for financial years 2004-05 to 2008-09 are displayed in the following tables. As noted above, information on methadone dispensing and supervision fees is not available centrally for all NHS health boards in each of the time periods under question. As a result, methadone dispensing and supervision cost information in tables 1 to 5 may not provide the complete picture across Scotland and comparisons over time must be treated with caution.

Please note that the data in tables 1 to 5 cover methadone and supervision fees paid centrally and exclude the supply of medicines to patients treated within hospitals and clinics.

Table 1: Total Drug Costs and Fees for Methadone Mixture: Items Dispensed in Scotland by NHS Board1

CCCCCC" cellpadding="2" cellspacing="0" dir="ltr" width="100%">
Dispensing NHS Board Financial year: 2004-05Gross Ingredient Cost (£)2Methadone Fees (£)3Supervision Fees (£)4Total Cost (£)
Ayrshire and Arran425,084.39656,600.15-1,081,684.54
Borders15,542.7720,067.25-35,610.02
Dumfries and Galloway92,222.60100,156.79164,853.04357,232.43
Fife157,121.28246,361.50-403,482.78
Forth Valley146,248.09337,584.77-483,832.86
Grampian339,562.50195,923.00664,308.361,199,793.86
Greater Glasgow and Clyde2,678,588.053,829,664.681,127,001.117,635,253.84
Highland73,085.5387,700.5167,416.17228,202.21
Lanarkshire364,832.26503,917.75-868,750.01
Lothian986,191.591,027,048.08-2,013,239.67
Orkney146.2135.006.40187.61
Shetland3,156.267,175.00-10,331.26
Tayside295,895.16325,081.05369,560.30990,536.51
Western Isles74.5494.50-169.04
Scotland5,577,751.237,337,410.032,393,145.3815,308,306.64

Source: Information Services Division: IR2010-00466.

Notes:

1. Data relates to methadone mixture and solution, 1mg/ml which are recognised as being the standard products for methadone programmes.

2. Total drug cost is the paid Gross Ingredient Cost (GIC).

3. Fees paid for dispensing methadone.

4. Fees paid for the supervision of methadone.

- = zero value.

Table 2: Total Drug Costs and Fees for Methadone Mixture: Items Dispensed in Scotland by NHS Board1

Dispensing NHS BoardFinancial year: 2005-06Gross Ingredient Cost (£)2Methadone Fees (£)3Supervision Fees (£)4Total Cost (£)
Ayrshire and Arran522,929.73796,176.01-1,319,105.74
Borders19,189.1323,726.50-42,915.63
Dumfries and Galloway100,707.56106,622.01197,878.98405,208.55
Fife185,806.48270,868.50-456,674.98
Forth Valley163,857.26374,747.28-538,604.54
Grampian406,887.75172,329.50839,370.701,418,587.95
Greater Glasgow and Clyde3,034,961.611,810,602.324,666,449.179,512,013.10
Highland99,571.31115,357.6888,888.90303,817.89
Lanarkshire428,893.35519,806.00-948,699.35
Lothian1,237,518.921,230,314.85-2,467,833.77
Orkney225.1888.2019.20332.58
Shetland5,821.888,622.25-14,444.13
Tayside294,655.78247,724.16526,019.211,068,399.15
Western Isles39.2342.00-81.23
Scotland6,501,065.175,677,027.266,318,626.1618,496,718.59

Source: Information Services Division: IR2010-00466.

Notes:

1. Data relates to methadone mixture and solution, 1mg/ml which are recognised as being the standard products for methadone programmes.

2. Total drug cost is the paid Gross Ingredient Cost (GIC).

3. Fees paid for dispensing methadone.

4. Fees paid for the supervision of methadone.

- = zero value.

Table 3: Total Drug Costs and Fees for Methadone Mixture: Items Dispensed in Scotland by NHS Board1

Dispensing NHS BoardFinancial year: 2006-07Gross Ingredient Cost (£)2Methadone fees (£)3Supervision fees (£)4Total Cost (£)
Ayrshire and Arran610,785.15899,155.30-1,509,940.45
Borders30,772.3616,789.5045,315.2492,877.10
Dumfries and Galloway116,275.33150,361.35236,756.66503,393.34
Fife251,247.31333,957.75-585,205.06
Forth Valley200,518.05246,817.28298,958.10746,293.43
Grampian492,155.30191,345.00977,989.401,661,489.70
Greater Glasgow and Clyde3,258,335.191,403,993.445,570,319.7810,232,648.41
Highland110,047.5860,524.22196,543.09367,114.89
Lanarkshire445,606.24523,129.25-968,735.49
Lothian1,388,292.561,399,650.00-2,787,942.56
Orkney412.5871.40403.20887.18
Shetland9,815.1612,015.50-21,830.66
Tayside291,925.94217,054.08566,920.421,075,900.44
Western Isles176.57119.00-295.57
Scotland7,206,365.325,454,983.077,893,205.8920,554,554.28

Source: Information Services Division: IR2010-00466.

Notes:

1. Data relates to methadone mixture and solution, 1mg/ml which are recognised as being the standard products for methadone programmes.

2. Total drug cost is the paid Gross Ingredient Cost (GIC).

3. Fees paid for dispensing methadone.

4. Fees paid for the supervision of methadone.

- = zero value.

Table 4: Total Drug Costs and Fees for Methadone Mixture: Items Dispensed in Scotland by NHS Board1

Dispensing NHS Board Financial year: 2007-08Gross Ingredient Cost (£)2Methadone Fees (£)3Supervision Fees (£)4Total Cost (£)
Ayrshire and Arran853,822.25630,730.28571,472.402,056,024.93
Borders42,938.2713,375.4456,401.08112,714.79
Dumfries and Galloway165,454.62163,507.20278,866.30607,828.12
Fife489,001.80221,102.00424,846.081,134,949.88
Forth Valley299,212.89205,239.65486,129.85990,582.39
Grampian753,978.26222,001.501,124,150.232,100,129.99
Greater Glasgow and Clyde4,202,404.021,600,138.465,740,005.5411,542,548.02
Highland161,204.7280,443.20211,443.66453,091.58
Lanarkshire563,373.64515,557.00-1,078,930.64
Lothian1,870,567.911,493,739.18-3,364,307.09
Orkney1,101.09172.20937.602,210.89
Shetland12,084.7910,606.75-22,691.54
Tayside420,718.47209,738.16663,453.011,293,909.64
Western Isles37.8310.50-48.33
Scotland9,835,900.565,366,361.529,557,705.7524,759,967.83

Source: Information Services Division: IR2010-00466.

Notes:

1. Data relates to methadone mixture and solution, 1mg/ml which are recognised as being the standard products for methadone programmes.

2. Total drug cost is the paid Gross Ingredient Cost (GIC).

3. Fees paid for dispensing methadone.

4. Fees paid for the supervision of methadone.

- =zero value.

Table 5: Total Drug Costs and Fees for Methadone Mixture: Items Dispensed in Scotland by NHS Board1

Dispensing NHS Board Financial year: 2008-09Gross Ingredient Cost (£)2Methadone Fees (£)3Supervision Fees (£)4Total Cost (£)
Ayrshire and Arran970,834.31471,041.41952,100.852,393,976.57
Borders55,785.1910,978.4274,800.86141,564.47
Dumfries and Galloway189,192.63170,377.04281,269.06640,838.73
Fife664,198.00190,018.50611,792.671,466,009.17
Forth Valley325,814.14210,720.21527,607.631,064,141.98
Grampian912,384.80257,855.501,214,841.122,385,081.42
Greater Glasgow and Clyde4,441,871.001,726,017.106,169,470.9612,337,359.06
Highland195,240.7097,652.64243,506.79536,400.13
Lanarkshire638,809.66570,914.75-1,209,724.41
Lothian2,007,952.461,090,313.58692,069.943,790,335.98
Orkney747.56130.20550.401,428.16
Shetland11,574.938,772.75-20,347.68
Tayside535,282.50290,498.40774,327.841,600,108.74
Western Isles17.477.00-24.47
Scotland10,949,705.355,095,297.5011,542,338.1227,587,340.97

Source: Information Services Division: IR2010-00466.

Notes:

1. Data relates to methadone mixture and solution, 1mg/ml which are recognised as being the standard products for methadone programmes.

2. Total drug cost is the paid Gross Ingredient Cost (GIC).

3. Fees paid for dispensing methadone.

4. Fees paid for the supervision of methadone.

- = zero value.

Does this answer the above question?

Yes1 person thinks so

No0 people think not

Would you like to ask a question like this yourself? Use our Freedom of Information site.