Methadone Treatment: Experiment and Experience

Abstract

The relationship between public policy and scientific investigation is explored by a review of the experience with methadone maintenance treatment for narcotic addiction. The implementation of a widespread treatment effort in Hong Kong in the 1970s is contrasted with recent policies in regard to methadone treatment expansion in the United States. In neither case did research findings form the basis for public policy. In Hong Kong, rapid expansion of methadone treatment was initiated before scientific evidence was available to support this course, and in the United States treatment expansion has been rejected despite extensive evidence of its utility and safety. Decisions by government officials and health care providers, as in the case of addiction treatment, may be influenced more by philosophy and intuition than by scientific evidence. Scientists must recognize and address this reality if they are to play a meaningful role in shaping public health policy.

Fortnightly Review: Methadone maintenance treatment in opiate dependence: a review

“…The effectiveness of low intervention methadone maintenance (that is, the provision of methadone without supportive services) is currently an issue of debate 71,72. This form of methadone maintenance is probably quite common in many countries (Britain and Australia, for example) but has been formally evaluated only in the trial conducted recently in New York by Yancovitz et al11 This study suggests that the provision of an adequate dose of methadone (60 mg) is sufficient to achieve reductions in heroin use, but the study period was very brief (one month) and further research is needed to establish the effectiveness or otherwise of providing methadone alone.…”

Alternate-day buprenorphine dosing is preferred to daily dosing by opioid-dependent humans

“…Requiring daily attendance may not be a satisfactory response to this diversion, because daily attendance increases costs and decreases the number of potential treatment slots relative to procedures that permit a lower frequency of clinic attendance. Moreover, federal, state and local funding reductions for United States methadone programs continue despite increasing demand for services as evidenced by long waiting lists at many publicly funded treatment centers (Newman and Peyser, 1991;Dennis et al 1994;Wenger et al 1994). Therefore, clinically viable alternatives to methadone that eliminate the need for daily dispensing without increasing the risk of medication diversion should enhance e¤orts to meet the demand for treatment in a safe, productive and cost-e¤ective manner.…”

Preventing and curtailing injecting drug use: a review of opportunities for developing and delivering ‘route transition interventions’

“…Even though the benefit from ancillary counselling in methadone programmes has been questioned [34], subsequent randomized treatment studies comparing methadone alone and methadone with low intensity and high intensity support [35] have found both low intensity and high intensity support to be associated with substantially better outcomes (and with the greatest benefit being seen with the high intensity support). Furthermore, McLellan [35] has also explored the extent to which this is associated with individual counsellors and their particular aptitudes and has found that the style of the individual therapists within methadone maintenance programmes is, itself, a significant influence on the extent to which they are effective.…”