The NHS has slashed spend on supervised methadone consumption in pharmacies in England by 10 per cent in just three years, a C+D investigation has revealed.

NHS spend on supervised consumption in pharmacies, including drug costs and pharmacy fees, fell from £8.8 million in 2009-10 to £8 million to 2011-12 across 66 PCTs in England.

Experts attributed the fall in supervised consumption spend to the coalition government's focus on drug-free recovery	More on methadone Change in supervised consumption spend by PCT PSNC announces revised methadone payment       structure MPs call for alternatives to methadone to be explored MORE NEWS
	The information, obtained by C+D under the Freedom of Information Act, found spend had decreased by up to 74 per cent in some areas. The trend mirrors NHS figures that show a 10 per cent fall in methadone hydrochloride prescriptions across England between 2009 and 2012.

Experts attributed C+D's findings to the coalition government's focus on drug-free recovery, but Public Health England stressed there was also a fall in the number of heroin addicts and increasing use of other opioid substitutes such as buprenorphine.

Contractor Al Patel said he had suffered a fall in methadone income at his Lee Pharmacy in Lambeth. Although his supervised consumption service was still "well worth it", he said his number of daily patients had reduced from 28 to about six or seven over the period of C+D's investigation.

Martin Bennett of Wicker Pharmacy, Sheffield estimated that spend on supervised methadone consumption in Sheffield could have fallen by half since 2009. Although Sheffield PCT was unable to provide C+D with data – the information is instead held by the local drugs and alcohol team – Mr Bennett said there had been funding cuts.

"We took a big hit to funding when methadone was transferred from the PCT to the drugs and alcohol team in July 2011," he told C+D. Despite only a "small drop" in the number of patients, Mr Bennett said the revised national pharmacy payment system, introduced last year, had further hit funding to the tune of £5,000-£6,000 a month.

Coventry and Warwickshire saw a 74 per cent drop in spend, which local LPC chief officer Les Yeates attributed to a stronger focus on drug-free recovery at a local level.

Source: C+D FOI requests to PCTs in England, January 2013; 66 responses

But pharmacists in other areas reported little change to their methadone income. Janet Aitken, pharmacy manager at Murrays Pharmacy in Cumbria, said the only hit to her business had arisen from a competitor pharmacy opening up nearby. And Ginny Henderson, pharmacist at Whitworth Chemists, Middlesbrough, said the number of methadone patients had remained "pretty much the same".

PSNC stressed that there was a national drive to decrease methadone use. "The government is very clear that it wants treatment to be focused on enabling drugs users to live completely dependence-free lives, and that includes being free from dependence on methadone," said Alastair Buxton, head of NHS services at PSNC.

Mr Buxton said there was still a need for methadone in some patients, however, where supervised consumption played a "vital" role in maintaining safety.

Addiction charities also voiced support for methadone treatment. Harry Shapiro, director of treatment and education charity Drug Scope, said the antipathy towards the drug was unjustified.

"Some say you might as well give whisky to alcoholics, but the reason we're doing this is based on clinical evidence," he told C+D. "This shows it's an effective way not only to treat addiction, but simply getting [users] onto treatment begins to stabilise their lives and reduces crime."

The comments were echoed by Tina Mobsby, head of the Clouds House rehab and detox centre in Wiltshire, run by charity Action on Addiction. "We do believe that methadone still has a very important place in reaching the long-term goal of abstinence and recovery," she argued. Mimi Lau, Numark's director of pharmacy services, stressed that pharmacists could offer a "complete package of care", as well as supervised consumption. Commissioners had been "looking down a funnel" and only seen pharmacy's supply function, rather than its potential to provide signposting and advice on issues such as sexual health and oral hygiene, she argued.  Vanessa Taylor, principal executive officer at East Sussex LPC, said she was already promoting the additional benefits of pharmacy to local commissioners. She argued that a fully drug-free recovery was not possible for everyone.
		The politics of methadone   David Cameron made his views on methadone clear before becoming prime minister in May 2010. Shortly before the general election, he criticised the treatment for failing to deal with the problem of drug abuse. His opinion of methadone appeared to have softened slightly by the time the coalition government released its drugs strategy in December 2010. The strategy said the drug would still have a role to play in treating addiction, but said this should only be for the small number who benefited from methadone. The government also named drug-free recovery as the main priority for its future strategy.

"The trouble is, the government strategy is to put [users] into a rehab programme to get them off methadone and that may not always be the solution," she told C+D. "It's not just about substance misuse, it's about the whole person – their environment, colleagues, friends, everything. Without good, sound support to come off substances, you're not going to be able to do it."

Public Health England told C+D that looking at methadone spend in isolation "did not give the full picture". "Other opioid substitutes such as buprenorphine can also be used and this needs to be taken into account," a spokesperson said.

Find out how supervised consumption spend changed in your PCT between 2009-10 and 2011-12.

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