Methadone occupies a position of huge prominence in drug misuse treatment to date. It is estimated there are around 650,000 illicit drug users receiving treatment globally (WHO 2008). Historically it was the earliest form of opioid replacement therapy and continues to be the most widely used form in the United States, Europe and Australia (Ward et al 1998). The most recent figures for Scotland show approximately 22,224 people are receiving methadone for drug misuse (Scottish Exec 2007). The effectiveness of methadone treatment is however questioned by some critics. This paper aims to describe methadone intervention treatment, look at the evidence surrounding it and discuss its effectiveness. For the purpose of this essay the history and treatment goals of methadone will be identified. The paper will then go on to discuss 4 main areas of debate in treatment, namely:
Reduction in criminal activity
Dosage of prescribed heroin.
Methadone maintenance treatment and HIV, Hep B and C.
Finally an overview of all of the evidence presented in the paper will be given and the future for methadone in drug misuse treatment discussed.
HISTORY AND DESCRIPTION OF METHADONE TREATMENT
In the USA in the early 1960’s Dole and Nyswander introduced orally administered maintenance doses of the synthetic opioid methadone as a drug substitution treatment for opioid dependence. The main aims of the introduction of this treatment were to reduce illicit drug use and criminal acts. The treatment was devised for established opiate addicts and was based on the principal that, prolonged opiate use caused certain physiological changes within the body which required effective treatment indefinitely (Ward et al 1998). The fundamental aspect of methadone treatment was that it blocked any effect the intake of heroin would cause and the person would fail to experience the euphoria effects. The person would in effect be able to function ‘normally on a day to day basis’. Methadone treatment provided a legal and controlled supply of an opioid drug which had to be taken only once a day because its long duration of action eliminated withdrawal symptoms for 24 to 36 hours. Relatively high doses of 80mg per day were thought necessary to achieve this. This dose was therefore prescribed on a long term basis with no intention that patients should attempt to reduce. The patient then had the opportunity to improve his/her social functioning by taking part in various psychotherapy and rehabilitation services which formed an essential part of the programme. (Dole and Nyswander 1967).
In the UK, the 1980’s brought methadone treatment to the fore. This was in response to the rise of HIV infection amongst the injecting drug misusing population. Methadone was seen as an important vehicle for shifting heroin users away from the risks of injecting (ACMD 1988). It was introduced as part of a harm reduction strategy to prevent the spread of HIV and AIDS (Seivewright 2000).
Since the 1960’s there has been a proliferation of variations on the basic Dole & Nyswander model of methadone maintenance. The organisation and regulation of treatment varies widely, with explicit guidelines for programme operation in the United States and Australia and a virtual absence of structure and regulation in Britain (Farrell et al 1994).
The treatment goals of many programmes have shifted from harm reduction and long term maintenance towards achieving abstinence from all opioid drugs including methadone within a few years (Seivewright 2000). Indeed The Scottish Government’s Review of Methadone in Drug Treatment 2007 stated:
“we believe absolutely that everybody who is on a [drug] programme should agree to move from a drug dependent lifestyle to a drug free lifestyle”.
This treatment model which is currently widespread in the UK today is largely based on the...