Earlier this month a two-year-old boy in Birmingham died from an overdose of methadone and his three-year-old brother was left seriously ill. This was the most recent of a number of high-profile cases over the years where children have managed to gain access to medication used routinely to wean addicts off heroin.
A 2003 study estimated that there were between 250,000 and 350,000 children of problem drug users in the UK. The general protection of children living in households where drug abuse is a problem poses major challenges to both GPs and social care workers.
Currently about 40% of people on treatment for heroin addiction are provided doses (methadone or buprenorphine) at supervised clinics. Other more "stable" patients are prescribed medication in larger quantities for self-administering at home. Identifying patients suited to the later option is a matter of risk assessment for the clinician but prescribing heroin substitutes comes with specific responsibilities in regard to the children of patients.
A guide to good practice in the management of controlled drugs in primary care (England) states that: "As with all prescribed medicines, dispensers should ensure that CDs are normally dispensed in child resistant containers, or with child-resistant closures. Advice to patients, their representatives or carers should include safe and secure storage at home, especially out of sight and reach of children, and safe disposal by returning any unused CDs to a pharmacy".
Such advice is best provided in both verbal and printed form as research has shown that recall of information on safety issues is poor.
ACTION: Clinicians must ensure that patients being issued prescriptions for heroin substitutes are provided with safety advice in regard to secure use and storage in the home. Ensure that you have a record that such advice was provided along with scripts or upon dispensing heroin substitutes. Dispensers should ensure that medications are supplied with child-resistant containers.