A leading doctor has said drug users should be given the same protections as disabled people and called for the Scottish Government to do more to defend methadone treatment.

The calls come days after Scotland announced record figures on deaths from drug misuse and amid debate over the use of opiate substitutes such as methadone. 

Dr John Budd, of the Edinburgh Access Project, a clinic for homeless patients, said methadone was clearly one of the best treatments for people with chronic drug problems, but had been “damaged” by a toxic debate over its use.

“The debate over methadone has been very unhelpful,” he said. “The international evidence is overwhelming that it is effective in terms of risk reduction, reducing overdoes death, blood-borne viruses, the reduction in criminality, an increase in life expectancy - more so than any other treatment I employ.”

However, criticism suggesting people were “parked” on the drug for lengthy periods has led to negative perceptions of methadone, and stigmatisation of people who are on it, he said. 

“The new drugs strategy talks about a rights-based approach. But there is still discrimination against people on the grounds that they are drug users. 

“The attacks on methadone are a form of discrimination,” he said.

“In terms of equalities law, chronic drug dependency should be seen as a disability, I would like to see that recognised in law.”

Read more: Scotland's drug death toll rockets as rethink is demanded

He said the Scottish Government could do more to defend the therapy, and pointed to national UK guidelines which make it clear the effectiveness of opiate substitution treatment is well evidenced.

They also state: “It is inappropriate … for services to create a sense that those opting for opioid substitute maintenance [such as methadone maintenance] are making a poorer choice than those opting for an abstinence-oriented or abstinence-based treatment.”

Dr Budd said: “Publicising the guidelines might be really helpful.”
He was backed David Liddell, director of the Scottish Drugs Forum, who said:

“We need a concerted effort to address this stigma and achieve a consensus that allows us to join the rest of Europe and the world in recognising that opiate substitution therapy (OST) is part of an evidence-based response to opiate drug use and that the quality of the services that deliver this is crucial.

Otherwise, we will continue to see people die needless and preventable deaths.

"The Government and politicians, the NHS, drug services, the media and wider society have a part to play in this.”

He said the way methadone is distributed should be reassessed. It is a requirement in many parts of the country that recovering drug users take daily supervised doses of methadone, usually in pharmacies, but Mr Liddell said the treatment had become so stigmatised that this was was exposing many to “ridicule and public humiliation”. 

Comment: Scottish ministers could - and should - do more to end drug deaths

However he said it might be easier to promote other types of OST. “The drip drip of negative stories means it is very hard to see how to change this, it has gone so far now.” 

With alternatives such as Buprenorphine and a slower-release morphine preparation becoming available, these and even the Heroin Assisted Treatment being brought forward in Glasgow might meet with a more sympathetic public response, he said. 

However an insider at one Scottish charity working with drug and alcohol abusers said many workers might be cautious about putting discrimination faced by drug users on a par with that affecting people with learning and physical disabilities. “I’m not sure everyone would agree with that,” he said.

Public Health Minister Joe FitzPatrick said: “Treatment for people who use drugs must be de-stigmatised and I would strongly encourage those in the public domain to be conscious of the impact that their criticism can have on those who benefit from such treatments. 

“While we are clear that prescribed drug treatment, like methadone, cannot be the only treatment option available on the path to recovery, its use can be a component of the treatment for opiate dependency, when provided as part of a package of care, treatment and recovery.  Treatment will be unique to each individual. 

“All medicines should be prescribed based on clinical need and discussed with patients within the context of their long-term recovery. Prescriptions should be reviewed regularly to achieve the best possible health outcomes and on-going support should be provided to patients. who are prescribed medicines that are known to be addictive.  We must also ensure the quality of this type of treatment, making sure people receive an optimal dose and that they are supported to remain in treatment for as long as may be required. ”