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Now this article could be as long as the magazine itself. Methadone
is the most researched aspect of drug treatment. So when we quote the
stuff that says short term prescribing is of little use, rest assured
that this reflects research findings across the world. But rather than
list all the studies that demonstrate this, weÕve chosen to quote from
two sources that carry especial weight.
The first comes from the US Institute of Medicine's study (1990) Treating
Drug Problems Vol 1. This was commissioned by the US Congress, approved
by the Governing body of the National Research Council and supported
by the National Institute on Drug Abuse and the US Department of Health
and Human Services. You can't get more kosher than this. Here is what
the IoM told the US Government about methadone treatment:
"There is strong evidence from clinical trials and other similar
study designs that, on average, heroin-dependent (or other opiate-dependent)
individuals have much better outcomes in terms of illicit drug consumption
and other criminal behaviour when they are maintained on methadone than
when they are not treated at all, when they are simply detoxified or
when methadone is tapered down and terminated arbitrarily."
We then turned to Ward et al's Methadone Maintenance Treatment (1998),
generally accepted as the most authoritative recent review of the world-wide
methadone literature. HereÕs what they say about short-term treatment:
"The original program devised by Dole and Nyswander (1967) for
methadone maintenance was a maintenance regimen. A return to this basic
philosophy is suggested by the evidence...The optimum duration for methadone
maintenance is, therefore, for as long as the patient benefits from
taking a daily dose of methadone, and given the chronic relapsing nature
of opiod dependence, there is no reason to believe that this would be
for a short period of time while heroin remains relatively freely available
in our society. (p.331)"
Even the new UK Clinical Guidelines (DoH 1999) endorse maintenance.
Given that practice in the drug treatment field should be governed by
evidence of what works, why are treatment agencies ignoring the international
research literature and going in for what we all know doesn't work?
If you're receiving short-term treatment and you haven't asked for it,
why not cut this article out and send it with a covering letter to the
Commissioner for Drug Services at your Health Authority? Make sure you
send a copy to the Chair of your local Drug Action Team as well.
Contact Monkey if you need details of where and how to complain.
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