I spent the day in a Dun Laoghaire methadone clinic. The building itself looks very ordinary and it's just called a "health clinic" so if I hadn't been told exactly where it was, I'd have no clue drug addicts were going there. The clinic is only open Monday-Friday since residents didn't want them open on the weekends...so most patients get a weekend supply of methadone. The clinic is open 8:45-12:45 for patients to get a dose of methadone and sometimes some other medications (antidepressants, sleep aids, multivitamins, etc). Some patients get a "take away" dose so that they only have to come in 3 times/week instead of everyday. The clinic deals with only a max of 100 patients at one time...so sometimes there can be a wait list.
When a patient comes in, they are asked by the pharmacist how they are doing, they can get a urine test to test for other opiods/BZDs/etc, and if they have a history of alcohol abuse they get a breathalyzer test. If they are under 0.08, they get their regular full dose. If it's above 0.08 and less than ~0.12 or 0.14 (can't remember), they get half the dose. If it's higher than that, they don't get any dose. If the patient doesn't come in for 3 consecutive days, they automatically get a lower dose. And if they want to get a higher dose, they need to see the doctor at the clinic. If they don't come in the proper days per week, they will be refused a weekend take-away dose.
In the afternoon, there is a shorter clinic that isn't open for general methadone services. It is reserved for those patients that are there to see the doctor or if they had special circumstances that they couldn't come in the morning. If a patient comes in the afternoon without an excused reason, they get a lower dose of methadone that their regular dose... For this reason, patients often try to make up excuses...but they don't allow for exceptions without documentation.
Because they dispense so much methadone, they order large bulk bottles of methadone (like the size of an antifreeze bottle). They also have pumps that can more accurately and quickly dispense out doses of methadone. I was curious if it had any specific taste, and one of the patients said it had a little bit of an odd taste but he couldn't link it to the taste of anything else. But it is a bit thick, so it can be hard to take down especially in higher doses.
A large proportion of the methadone patients at this clinic have alcohol abuse issues, so I got to see lots of breathalyzer tests and a lot of reduced doses. For the most part, the patients were calm and friendly. Many looked like they'd be addicts, but some looked so surprisingly normal...which was even more of a shock to me. It was also interesting to see the large range of dosing...some people were fine on 40 ml, while others were taking 120+ml. There were a couple of patients that caused a stir...which the pharmacists just deal with them frankly and go on with the day. I got to experience a few of those lovely patients.
According to the pharmacists, heroin use has definitely come down in Ireland...but it continues to be a problem since it's easy to come by. They also mentioned the there's another problem becoming popular (similar to the USA)--"HeadShop bath salts." People are using these in large doses and they are noticing that these people are becoming psychotic...often times being committed in the hospital for a while. For those with underlying psychotic diseases, it can aggravate it or trigger the development of their psychosis...Like in the States, they keep banning the substances, but manufacturers of the drugs just chemically alter it slightly so that it isn't illegal.
Overall, a very interesting day in the pharmacy.
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