A man had been in a methadone programme for 30 years when he decided he wanted to voluntarily reduce his dose. He wanted to end opioid substitution treatment (OST) entirely and, with the support of his dispensing pharmacy in Tauranga, began to gradually reduce his methadone dose. But in May 2021, after 10 months of gradual reduction, the Bay of Plenty Addiction Service informed him his “lack of engagement” with the service meant he’d be subject to involuntary rapid withdrawal of methadone, which was implemented between August 7-14, 2021. About six weeks later, the man died from “mixed drug toxicity”. Post-mortem toxicology testing confirmed a level of methadone that “can be toxic to an individual who does not have a tolerance to the drug” as well as other drugs in his system. Now, Health and Disability Commissioner Morag McDowell has found Health New Zealand, which runs the Bay of Plenty Addiction Service, was in breach of the Code of Health and Disability Services Consumers’ Rights. Health and Disability Commissioner Morag McDowell. Photo / Supplied It had involuntarily withdrawn the man, referred to in the findings as Mr A, without “reasonable grounds or exploration of all alternative strategies, at a dangerously rapid rate, and without appropriate advice or support”. The HDC inquiry was conducted in conjunction with another case, from 2023, where a woman was taken off methadone and put on another treatment “under duress”, causing her “acute and unnecessary discomfort and distress”. In both cases, Health NZ BOP was criticised for the clinical decisions and lack of communication with the methadone users. Both decisions highlighted a letter from the HDC to the Director of Mental Health and Addiction Services, sent in October 2023, which expressed concerns that many OST services were being provided in a way that was “inconsistent with people’s rights under the code”. It said OST consumers were not always “being respected as partners in their care and that treatment planning or decisions to amend or discontinue treatment were being made without consumers being involved in those discussions”. Specific concern was expressed about the involuntary withdrawal of methadone, at rates far from gradual and for reasons unclear to consumers. Mr A‘s ‘unfair and cruel’ involuntary reduction Mr A had decided he wanted to withdraw from the methadone programme entirely. He didn’t like having to go to the pharmacy for medication every morning, finding it burdensome, but he was required to because of his “contentious use of cyclizine”, which meant he wasn’t eligible for “takeaway doses”. Cyclizine is an antihistamine used to treat nausea or vomiting from motion sickness, which Mr A said he used for seasickness. It can also enhance the effect of opioids and is regarded as a drug of abuse by people using methadone. Mr A’s pharmacist, Mr B, was found in breach after he, during the period of voluntary withdrawal, gave Mr A reduced doses of methadone, at his request, without authorisation from the prescriber, Bay of Plenty Addiction Services. The HDC found there were three occasions when Mr B dispensed a reduced dose without authorisation, and Mr B was found in breach of the code. But the second breach was by Health NZ Hauora a Toi Bay of Plenty. The possibility of involuntary withdrawal of Mr A’s treatment was first suggested at a medical review in November 2020. Mr A’s use of cyclizine was discussed, and he was reminded that he needed to attend appointments while he remained in treatment. A plan was suggested for monthly appointments, however, an adviser to the HDC, Dr Ivan Srzich, noted it wasn’t clear whether a plan for Mr A to attend more regular appointments was discussed in “any collaborative way”, nor did it appear “clinically warranted”. Mr A was stable, undertaking a voluntary managed dose reduction, with no evident risks or challenging behaviours. While the ongoing cyclizine use was not condoned, it did not raise clinical risks. He...