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Methadone may be an imperfect treatment, but it's a necessary one Methadone may be an imperfect treatment, but it's a necessary one
(7 months later)
From time to time tragedies draw attention to enduring public health problems and, often transiently, focus our combined anxieties and anger at the lack of a solution. Like rogue dog attacks, random shootings and murdered prostitutes, drug and alcohol addiction problems are a reminder of a resident evil we would rather do without.From time to time tragedies draw attention to enduring public health problems and, often transiently, focus our combined anxieties and anger at the lack of a solution. Like rogue dog attacks, random shootings and murdered prostitutes, drug and alcohol addiction problems are a reminder of a resident evil we would rather do without.
The case of the sad death of a child from the diversion of a medication such as methadone generates anger, fear and hostility towards the obvious targets: the parents and the supplier of the lethal drug. This, we say, is collateral damage of an unacceptable degree from a treatment designed to help a specific condition, in this case heroin dependency.The case of the sad death of a child from the diversion of a medication such as methadone generates anger, fear and hostility towards the obvious targets: the parents and the supplier of the lethal drug. This, we say, is collateral damage of an unacceptable degree from a treatment designed to help a specific condition, in this case heroin dependency.
Like other events that are uncomfortable and fundamentally sad for all involved, simple solutions are urgently demanded and are incomplete, temporary and inadequate. There is no simple solution and, in common with other areas of complex human behaviour, a better understanding of the causes is required. Like other dangers, methadone has to be seen as such and procedures put in place to minimise the possibility of secondary harm. This treatment, properly applied for a serious medical disorder, remains important and its benefits outweigh its risks.Like other events that are uncomfortable and fundamentally sad for all involved, simple solutions are urgently demanded and are incomplete, temporary and inadequate. There is no simple solution and, in common with other areas of complex human behaviour, a better understanding of the causes is required. Like other dangers, methadone has to be seen as such and procedures put in place to minimise the possibility of secondary harm. This treatment, properly applied for a serious medical disorder, remains important and its benefits outweigh its risks.
Evidence for the importance of an intervention such as methadone comes from a variety of sources. Guidelines for treatments such as this rely heavily on scientific evidence and on organisations such as the National Institute for Health and Clinical Excellence (Nice) evaluating the strength of the arguments in favour and against. Over many years the value of methadone has been established. It undoubtedly saves lives and normalises lifestyles. An additional imperative for treatment comes from public health. The risk of epidemic spread of viruses from sharing needles to inject heroin, which causes death from HIV, hepatitis and hepatitis C, is a powerful argument for an intervention shown to mitigate these dangers. Dangers which, of course, threaten not just those injecting drugs but their sexual partners and ultimately all of us in one way or another.Evidence for the importance of an intervention such as methadone comes from a variety of sources. Guidelines for treatments such as this rely heavily on scientific evidence and on organisations such as the National Institute for Health and Clinical Excellence (Nice) evaluating the strength of the arguments in favour and against. Over many years the value of methadone has been established. It undoubtedly saves lives and normalises lifestyles. An additional imperative for treatment comes from public health. The risk of epidemic spread of viruses from sharing needles to inject heroin, which causes death from HIV, hepatitis and hepatitis C, is a powerful argument for an intervention shown to mitigate these dangers. Dangers which, of course, threaten not just those injecting drugs but their sexual partners and ultimately all of us in one way or another.
Familiar arguments against long-term methadone treatment are as follows:Familiar arguments against long-term methadone treatment are as follows:
When drug users are engaged in an activity that is amenable to behavioural therapy and given adequate encouragement and opportunity, recovery is achievable, in the form of abstinence from all addictive substances. Furthermore, research increasingly suggests that extended dependency leads to structural and possibly irreversible neurological change obstructing progression to abstinence. It is argued that provision of a treatment such as methadone merely locks the individual into perpetual dependence and a state of hopelessness.When drug users are engaged in an activity that is amenable to behavioural therapy and given adequate encouragement and opportunity, recovery is achievable, in the form of abstinence from all addictive substances. Furthermore, research increasingly suggests that extended dependency leads to structural and possibly irreversible neurological change obstructing progression to abstinence. It is argued that provision of a treatment such as methadone merely locks the individual into perpetual dependence and a state of hopelessness.
However, recently published research suggests that injecting drug use is more common in people with childhood adversity, sexual abuse and other traumas and disrupted childhood experiences. Addiction to drugs or alcohol is associated with inequalities, deprivation and other personal or situational difficulties. This, for many, represents a behaviour deeply embedded and consequently not easily removed. Long-term treatment may not be required for everyone who has ever used opiates, but for some it is a lifeline and an essential support.However, recently published research suggests that injecting drug use is more common in people with childhood adversity, sexual abuse and other traumas and disrupted childhood experiences. Addiction to drugs or alcohol is associated with inequalities, deprivation and other personal or situational difficulties. This, for many, represents a behaviour deeply embedded and consequently not easily removed. Long-term treatment may not be required for everyone who has ever used opiates, but for some it is a lifeline and an essential support.
Recent debates have concentrated on optimising treatments such as methadone. Better outcomes are expected and better interventions required allowing recovery in whatever form that might be achieved. For some this is absolute abstinence from all drugs, for others it is stability and the absence of illegal and dangerous drug use. All mechanisms and techniques should be available and, most importantly, should be assessed for efficacy and cost-effectiveness.Recent debates have concentrated on optimising treatments such as methadone. Better outcomes are expected and better interventions required allowing recovery in whatever form that might be achieved. For some this is absolute abstinence from all drugs, for others it is stability and the absence of illegal and dangerous drug use. All mechanisms and techniques should be available and, most importantly, should be assessed for efficacy and cost-effectiveness.
Along with this new energy to succeed and to achieve the aspirations of dependent persons, therapists have to be pragmatic and recognise that treatments are all imperfect and outcomes are unpredictable. An open mind is required and a willingness to experiment and maximise therapeutic opportunities. This includes the recognition that for some, lifelong methadone is necessary, for others, methadone in combination with rehabilitation and recovery in its many formats should be available and should be treated with the expertise and dignity offered with all other health and care interventions.Along with this new energy to succeed and to achieve the aspirations of dependent persons, therapists have to be pragmatic and recognise that treatments are all imperfect and outcomes are unpredictable. An open mind is required and a willingness to experiment and maximise therapeutic opportunities. This includes the recognition that for some, lifelong methadone is necessary, for others, methadone in combination with rehabilitation and recovery in its many formats should be available and should be treated with the expertise and dignity offered with all other health and care interventions.
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