Medical profiteering: the economics of methadone dispensation

Bohdan Nosyk; Aslam H. Anis

doi:10.1503/cmaj.081513

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methadone profiteering
anthony c carr

Posted on: 01 June 2009
Thoughts on alleged methadone "profiteering"
Robert G. Newman

Posted on: 29 May 2009

Posted on: (1 June 2009)
Page navigation anchor for methadone profiteering
methadone profiteering
anthony c carr
The interesting article on "Economics of methadone dispensing" (CMAJ 26 May 09) contains several logical errors, making further discussion difficult.
It is cheaper to dispense methadone via pharmacies than to in clinics or doctors' offices, but this does NOT mean that "consumer surplus (utility gain) ... are maximized". We could simply execute all opiate addicts - it would be way cheaper! Your writers have fai...
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The interesting article on "Economics of methadone dispensing" (CMAJ 26 May 09) contains several logical errors, making further discussion difficult.
It is cheaper to dispense methadone via pharmacies than to in clinics or doctors' offices, but this does NOT mean that "consumer surplus (utility gain) ... are maximized". We could simply execute all opiate addicts - it would be way cheaper! Your writers have failed to consider the quality-of-life changes: methadone clinics may help the consumer much more than a busy pharmacist.
The fact that deregulation has led to "a 240% increase in ... patients in [methadone] treatment" does NOT mean that the treatment is working, or that we must "ensure widespread access". It simply means that addicts like procuring free methadone - especially if bribed by pharmacists.
The reasons that crack cocaine use is more common among "enrolment in a methadone maintenance program" are simple. Methadone clinics are a great place to meet your friendly neighbourhood crack dealer. And clinic doctors are not rigorously refusing to give methadone to patients who continue to abuse other drugs.
Ethics in Canada are at a low ebb. Even so, it is astonishing to find authors condoning pharmacists who illegally siphon government money into addicts' pockets for them to spend "77% of their income on illicit drugs". Is this really consumer gain?
Yours, Tony Carr
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (29 May 2009)
Page navigation anchor for Thoughts on alleged methadone "profiteering"
Thoughts on alleged methadone "profiteering"
Robert G. Newman
TO THE EDITOR: re “Medical profiteering: the economics of methadone dispensation”1, it is difficult to imagine that pharmacists are “paying patients up to $10 a day” when the total dispensing fee they receive is said to be $16.60! Furthermore, the concern that such payments will commonly be used to acquire other drugs seems greatly overstated. After all, compared to even the most generous pharmacy payoffs methadone maintenanc...
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TO THE EDITOR: re “Medical profiteering: the economics of methadone dispensation”1, it is difficult to imagine that pharmacists are “paying patients up to $10 a day” when the total dispensing fee they receive is said to be $16.60! Furthermore, the concern that such payments will commonly be used to acquire other drugs seems greatly overstated. After all, compared to even the most generous pharmacy payoffs methadone maintenance itself, to a vastly greater extent, “eliminates the need to purchase illicit heroin”. If such “savings” were merely diverted to purchase of “crack or other illicit drugs” we would not have the consistently reported evidence of the efficacy of this treatment. Robert G. Newman, MD, MPH, Director Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center, NY, NY, USA REFERENCE: 1. Nosyk B and Anis AH. 2009. Medical profiteering: the economics of methadone dispensation. CMAJ. 180(11):1093-94
Conflict of Interest:
None declared
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Competing Interests: None declared.