Ex-Addict Advised [Deadly] Methadone Dose

[Tchort]

BBC News: Scotland

May 26 2009

Ex-Addict Advised Methadone Dose

Mr Nichol died of a methadone overdose after entering the clinic
An inquiry into the death of a man in a clinic has been told the doctor who prescribed a methadone dose which later killed him was himself a former addict.

Dr David McCartney had been "clean" for two years before he prescribed the heroin-substitute to 20-year-old Kieran Nichol at Castle Craig Hospital.

Mr Nichol died of a methadone overdose two days after being admitted to the Borders clinic in November 2005.

The fatal accident inquiry at Edinburgh Sheriff Court continues.

The inquiry has heard that Mr Nichol was an occasional user of heroin but was not addicted to the drug.

Physical signs

It was his second stay in the hospital, at Blyth Bridge in the Borders, for treatment for an addiction to valium and alcohol.

Dr McCartney, who now heads the Lothians and Edinburgh Abstinence Programme (LEAP), said his own experience of heroin addiction made him better-equipped to help others.

He was the clinical assistant at the hospital and examined Mr Nichol, from Hawick, when he arrived.

He said Mr Nichol told him he had been using between £60 and £80 worth of heroin a day, and Dr McCartney said there were physical signs - including pin-point pupils - to back this up.

He prescribed 30mg of methadone, despite conceding that there was no way of knowing what Kieran's tolerance level to the drug was.

He was given three doses in just over 24 hours, totalling 90mg of methadone, and died shortly afterwards.


Dr McCartney told the court he felt the clinic had proper safeguards
Dr McCartney admitted he could have waited to see if Kieran showed any signs of heroin withdrawal before prescribing methadone, but said that was not the procedure at Castle Craig.

Nursing staff on duty were free to contact doctors after hours or vary prescriptions if patients showed ill effects to medication, he said.

"I was comfortable when I left work on the Friday night that there were enough safeguards in place," said Dr McCartney.

Fiscal depute Angus Reith asked him if it would not have been safer to wait for signs of withdrawal before prescribing methadone.

"Yes that would be the safest thing to do," said Dr McCartney.

"I think with all the information I have heard I think it would be safer to wait until the signs of withdrawal."

However, he denied that he would have acted differently in Mr Nichol's case, even with hindsight.

"I don't think I could have done anything else," said the doctor.

"What happened wasn't what I expected to happen," he added.

The inquiry, before Sheriff Gordon Liddle, continues.

http://news.bbc.co.uk/2/hi/uk_news/scotland/south_of_scotland/8067900.stm

 

[phr]

Dr McCartney admitted he could have waited to see if Kieran showed any signs of heroin withdrawal before prescribing methadone, but said that was not the procedure at Castle Craig.

I'm surprised this isn't part of the sop. At least it is in the methadone clinics here, along with preliminary, and later lab results of a drug test.

 

[Tchort]

I've always admired European MMT/BMT procedures. It's great that a doctor in Scotland has the power and authority to prescribe an adequate dose of Methadone for his patients (rather than having to bump them up 5 or 10mg every day or 3 in the US) on day 1. However, not waiting to witness withdrawal symptoms is nuts.

I remember reading a figure that up to 30% of the people who seek Methadone maintenance are not even dependant on opioids I'll see if I can find that article again.

 

[Hammilton]

Weird. Honestly, though, I was never required to show withdrawal syndrome before methadone or suboxone.

Before suboxone, I was just told to not take anything for at least 24 hours or I'd regret it.

With methadone, I just told them that I was on suboxone, and I was, and that I wanted to switch to methadone. Now that I live closer than the 1.5 hour drive, I'm probably going to go back to methadone. They didn't require that I be in withdrawal. Hell, actually, the first time I went there they ran me through the questionaires and stuff, had me take a piss test and then offered me 30mg in that vile liquid. I declined and asked for 20mg. Good thing, because I was actually pretty high from that.

Who would have thought: I was only 18 hours after my last 8mg suboxone dose! I could barely make the drive home, by the time I was 10 minutes from my house my eyes were dropping and I was itching like hell. I ended up pulling over 5 minutes away and passing out for an hour. I woke up, puked and went to a job interview. Got it, but can't believe it.

If I go back, I'm going to task for 15mg the first time.

 

[Tenchi]

Had to be someone from the town I was born in, didn't it?

 

[qwe]

wouldn't the doctor have witnessed alcohol withdrawal and concluded that that was opiate withdrawal because of the similarities, whether he was hooked on opiates or not...?

90mg/day as a starting dose!? with co-occuring valium and alcohol abuse!??!?!!?

 

[Tchort]

wouldn't the doctor have witnessed alcohol withdrawal and concluded that that was opiate withdrawal because of the similarities, whether he was hooked on opiates or not...?

90mg/day as a starting dose!? with co-occuring valium and alcohol abuse!??!?!!?

Europeans are much, much more forgiving about co-occuring poly drug use. I almost got canned after a single Benzo positive, and had another positive because I was too nervous to talk to my counselor about it for fear of being kicked out (though people at my clinic have been dropping like flies lately from them. A guy in line behind me almost passed out on me last week from Xanax).

I get the feeling the guy wasn't experiencing abstinence syndrome from alcohol or Valium, but had admitted himself voluntarily for treatment for compulsive use of both.

 

[qwe]

^ i know and i dont disagree with anything you said

but shouldn't they be more careful than starting someone at 90, when they are abusing benzos and alcohol? im not saying they shouldnt get into the program, but if the dude got (like is S.O.P) plenty of education about the dangers of mixing methadone with depressants like here, and if the staff takes into account the triple depressant danger,

the right thing to do would be to wait until he's in withdrawal from his D.O.C. (so they don't combine...) and educate him about triple depressants and overdose

and they probly did that. so he probly was just trying to score drugs to add to his cocktail it seems to me...

 

[Tchort]

Update

Update for this article.

A young drug addict was prescribed too much methadone at a Borders clinic where he later died, a consultant psychiatrist has told an inquiry.

Kieran Nichol, 20, of Hawick, was given three doses totalling 90mg in little more than 24 hours in December 2005.

He was later found dead in his bed at the Castle Craig clinic near Peebles.

Dr Eilish Gilvarry, an addictions expert, said the dosage was "too high" given the uncertainty about Mr Nichol's tolerance level. The inquiry continues.

The fatal accident inquiry, at Edinburgh Sheriff Court, has heard Mr Nichol told clinic staff he had developed a £60-a-day heroin habit in less than two months.


It doesn't require specialist knowledge to recognise if someone is grossly sedated, I would expect any professional to recognise that

Dr Eilish Gilvarry
However, his mother, Jacqueline Nichol, told the hearing her son had only smoked heroin twice and was not addicted to the drug.

The inquiry was also told no urine sample was taken from Mr Nichol to check for heroin use before he was prescribed methadone and diazepam.

He was given three 30mg doses of methadone despite showing signs of being over-medicated.

Dr Gilvarry said the initial dose should have been much lower and no further prescriptions should have been written until Mr Nichol showed signs of withdrawal.

She said an appropriate first dose would have been around 5mg, although the guidelines permitted up to 40mg.

But adding a further 60mg the following day was outside the guidelines, she said.

'Over-sedated'

"I consider the doses of methadone and diazepam together slightly concerning, particularly in view of the inconsistent history," said Dr Gilvarry.

"I think the doses were too high."

She said medical staff should have closely monitored Mr Nichol for symptoms of withdrawal after giving him the first dose.

She added that nurses should have realised Mr Nichol was "over-sedated" and called an ambulance or the doctor instead of sending him to bed.

"It doesn't require specialist knowledge to recognise if someone is grossly sedated, I would expect any professional to recognise that," she added.

Mr Nichol died at the private hospital in Blyth Bridge on 11 December 2005.

The inquiry, before Sheriff Gordon Liddle, continues.

http://news.bbc.co.uk/2/hi/uk_news/scotland/south_of_scotland/8094676.stm

 

[kronix420]

i go to a clinic and i gotta say the Dr should no better then to do that. Methadone is different from person to person a 90 mg dose can easily kill someone that doesn't have a tolerance. The doc should of known better its just stupid of him. Yea people at clinics get 150 doses in way higher but they start at 30 n go up day to day till they get the right dose for them.

 

[robatussin]

The doctors must have not had the time to check 2 hours after dosing her 30 and redosing, they could have said call us if you need more. Also I do agree a lot of occasional pill users want to get into that without realizing what problems that makes. I almost went on it but did not. I am on suboxone now and happy I am on that end of the line, though i cant resist full agonism 100% of the time

 

[Tchort]

The first article states that he presented to the rehab for alcohol and Diazepam abuse, and that he was given for 90mg Methadone over the course of just over 24 hours, due to a fictitious Heroin addiction. The second article states that he was given 90mg Methadone and an unspecified amount of Diazepam as well, the combination of these two drugs is probably what killed him.

Most Heroin users, when asked at an MMT clinic to describe their average daily amount of Heroin used, usually exaggerate a little. But, apparently this guy was neither dependant or a regular chipper- his mother thinks he only used Heroin twice in his life.

It sounds like he was trying to get high on Methadone by lying to the doctors about a Heroin addiction, and might have lied after each dosing saying he was still feeling dopesick.

I read a statistic awhile back that up to 30% of the people seeking Methadone maintenance are not actually dependant on opioids (don't know if this is accurate or not). However, simply checking for recent opioid use via a urine test is not a foolproof way to establish addiction either. Given the prevalence of OTC Codeine tablets in the UK, it would be easy to pass a UA for opiates and fake a Heroin addiction, leading to Methadone dosing.

A L60 a day Heroin habit would require 80-120mg Methadone a day to treat in most cases. I'm on the side of the doctors on this one after reading the second article. It seems clear the guy wanted to get loaded in rehab, lied many times to treatment personnel, and died as a result. Suicide by doctor.