Tuesday, February 14, 2006


The following question was posted recently on a drug-issues related list-serve. "How many clients is it safe to dose in a given time frame, and how much time should be allocated to each client."

A seemingly reasonable query, but ... With respect, when the option is to leave heroin dependent people who desperately want and need treatment out on the streets to shoot dope, "optimal" numbers to accommodate in methadone treatment becomes the wrong question - whether posed in absolute terms, or patients per hour, or services per patient per visit.

How bad or time-constrained does a service have to be to be a worse option than rejection and abandonment (if it were my kid, it would have to be pretty God-awful for me to agree with a decision that denied any/all help). As for specifics, for decades there have been clinics in Hong Kong that in the space of 45-60 minutes provide the individually prescribed dose of methadone to many hundreds of patients - and there the process includes first paying a $HK1 fee to the cashier, and the dispensing of meds is done not by nurses but by an "auxiliary medical staff"

Again, the burden is on the provider to justify abandonment on the basis of "we can't treat more patients. Considering the consequences for those NOT treated the threshold should be mighty high indeed.

(An additional observation: referring to "dosing" of patients seems demeaning and dehumanizing. Maybe one "doses" chickens or cattle, but patients are "medicated," - but hell, I guess it's much better to "dose" patients who need medication than to abandon them, which is the substantive issue here.)


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