A 1990 Institute of Medicine report concluded that there is strong evidence from clinical trials and other studies that heroin-dependent individuals have better outcomes on average when they are maintained on methadone than when they are not treated at all, acutely detoxified and released, expelled from treatment, or when the treatment program is closed. Methadone programs have higher rates of retention in treatment for opioid-dependent patients than do other treatment modalities applied to similar patient populations. There is evidence that methadone treatment is effective in reducing exposure to HIV infection by reducing intravenous drug use and by decreasing needle sharing. Treatment that reduces street drug injection and needle-sharing will reduce the spread of HIV infection. Medical maintenance may be an efficient and cost effective approach to the related major problems of opioid dependence and an evolving HIV epidemic.
Further investigation is needed to define the critical details of such programs.
The following statements, recommended by the Council on Scientific Affairs, were adopted as AMA Policy at the 1994 AMA Interim Meeting.