Methadone

Methadone is prescribed to heroin addicts as a substitute for heroin. Prescribing methadone as a heroin substitute was the first outpatient treatment that heroin addicts would attend reliably. Since the early studies hundreds more have shown that maintenance treatment with methadone reduces (though it does not eliminate) the use of opiates and criminal behaviourJames L Sorensen, Editorials: Methadone treatment for opiate addicts, British Medical Journal, BMJ 1996;313:245-246 (3 August). Methadone treatment has been known to reduce illicit use of herion and criminal actions and lower the risk of HIV infection mortality and improves social rehabilitationBertschy G., Methadone maintenance treatment: an update, Europe Arch Psychiatry Clin Neuroscience 1995;245:114-24. As well as in the UK methadone is used to treat heroin addiction in the United States and GermanyJames L Sorensen, Editorials: Methadone treatment for opiate addicts, British Medical Journal, BMJ 1996;313:245-246 (3 August).
Writing in the BMJ James Sorensen makes the case for methodone treatment:
:Methadone treatment is not a panacea, and it has always been controversial. Giving an addictive substance to an addict raises objections from many sources. When methadone is prescribed or supplied directly it may create iatrogenic addiction by being sold for illicit use. About a tenth of the prescriptions reported by Strang et al were for tablets, which can be ground up and injected, and a tenth for injectable ampoules. It has been suggested that countries such as Britain, where use of methadone is less closely regulated, have more scope for diversion of methadone to people not being prescribed the drug. A third paper in this issue supports this suggestion. Cairns et al (p 264) report that deaths in Manchester involving methadone increased from 10 in 1985-90 to 80 in 1990-4. Only two fifths of those deaths occured in people who were being prescribed methadone. Another drawback is that methadone is not a treatment for abuse of cocaine. One recent study of 229 patients taking methadone found that their abuse of opiates had decreased with time in treatment, but their use of cocaine continued and did not seem to be related to the length of time in the programmeJames L Sorensen, Editorials: Methadone treatment for opiate addicts, British Medical Journal, BMJ 1996;313:245-246 (3 August).
:A dose of methadone has no magical effect on the personality, job skills, or support systems of a drug abuser. Programmes that offer little in the way of counselling, employment support, or training in the prevention of relapse are unlikely to make much change in social functioning. Perhaps for this reason a recent study of opiate users in Amsterdam (where methadone is available as a "low threshold" treatment with relatively little ongoing counselling) concluded that methadone in itself had no effect on the extent of drug users' criminal behaviour. Methadone programmes attract a highly disadvantaged population, and rehabilitation is a long, difficult process for them, fraught with the danger of relapseJames L Sorensen, Editorials: Methadone treatment for opiate addicts, British Medical Journal, BMJ 1996;313:245-246 (3 August).
Methadone is not a miracle cure; it should not be oversold and then be criticised for failing to live up to unrealistic expectations. As an outpatient treatment of opiate abuse methadone is extremely effective. After 30 years our opinion of the treatment may need some modification, but not much. Newman's article about the growth of methadone treatment in Germany seemed to strike the right balance: "What is needed today is not further discussion, but a firm commitment to make treatment available on request to every addict willing to accept it. There is no justification for settling for less."James L Sorensen, Editorials: Methadone treatment for opiate addicts, British Medical Journal, BMJ 1996;313:245-246 (3 August).
==Resources==
*Carnwath, T., Gabbay, M, Perry, M, Benbow, E. W, Roberts, I. S D, Cairns, A. (1997). Fatal methadone overdose. BMJ 315: 55-55 
*Robertson, J R, Macleod, J (1996). Methadone treatment. BMJ 313: 1480c-1481 
*Merrill, J., Garvey, T., Rosson, C. (1996). Methadone concentrations taken as indicating deaths due to overdose need to be reviewed. BMJ 313: 1481a-1481
*Dole VP, Nyswander M. A medical treatment for diacetylmorphine (heroin) addiction. JAMA 1965;193:80-4. 
*Bertschy G. Methadone maintenance treatment: an update. Europe Arch Psychiatry Clin Neuroscience 1995;245:114-24. 
*Institute of Medicine. Federal regulation of methadone treatment. Washington, DC: National Academy Press, 1995. 
*Gerstein DR, Harwood HJ, eds. Treating drug problems. Washington, DC: National Academy Press, 1990. 
*Office of Technology Assessment. Effectiveness of drug abuse treatment: implications for controlling AIDS/HIV infection. Washington, DC: US Government Printing Office, 1990. 
*Newman RG. Another wall that crumbled--methadone maintenance treatment in Germany. Am J Drug Alcohol Abuse 1995;21:27-35. 
*French MT, Zarkin GA, Hubbard RL, Rachal JV. The effects of time in drug abuse treatment and employment on post-treatment drug use and criminal activity. Am J Drug Alcoh Abuse 1993;19:19-33. 
*Brecht M, Anglin MD, Wang J. Treatment effectiveness for legally coerced versus voluntary methadone maintenance clients. Am J Drug Alcohol Abuse 1993;19:89-106.
*Bell J, Hall W, Byth K. Changes in criminal activity after entering methadone maintenance. Br J Addict 1992;87:251-8.
*Metzger DS, Woody GE, McLellan AT, O'Brien CP, Druley P, Navaline H, et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquired Immune Deficiency Syndrome 1993;6:1049-56. 
*Farrell M, Neeleman J, Gossop M, Griffiths P, Buning E, Finch E, et al. Methadone provision in the European Union. Int Journal of Drug Policy 1995;6:168-72. 
*Sheridan J, Strang J, Barber N, Galnz A. Role of community pharmacies in realtion to HIV prevention and drug misuse: findings from the 1995 national survey in England and Wales. BMJ 1996;313:272-4.
*Strang J, Sheridan J, Barber N. Prescribing injectable and oral methadone to heroine misusers: results from the 1995 national postal survey of community pharmacies in England and Wales. BMJ 1996;313:270-2. 
*Farrell M, Ward J, Mattick R, Hall W, Stimson GV, Des Jarlais D, et al. Methadone maintainance treatment in opiate dependence: a review. BMJ 1994;309:997-1001. 
*Cairns A, Roberts ISD, Benbow EW. Fatal methadone overdose--the Manchester experience. BMJ 1996;313:264-5.
* Gottheil E, Sterling RC, Weinstein SP. Diminish illicit drug use as a consequence of long-term methadone maintenance. J Addict Dis 1993;12:45-57. 
* Grapendaal M. Cutting their coat according to their cloth: economic behavior of Amsterdam opiate users. Int J Addict 1992;27:487-501.
==Notes==
Category:Addictions