Report of the Council on Scientific Affairs

Abstract

Extensive evaluation studies show that methadone maintenance therapy (MMT) reduces heroin use and associated problems in a cost-effective manner, without negative public health impact. MMT is limited by inadequate funding and understanding of relevant research, extensive regulation, and limits on the freedom of physicians to provide methadone in a variety of medical settings. Broad-based medical, public health, and scientific support exists for expansion of MMT with greater emphasis on consistency and quality, and provision of ancillary services. Programs for the exchange, free distribution, and legal pharmacy sale of needles and syringes reduce injection drug use and prevent the spread of bloodborne pathogens; drug abuse treatment and other services are important components. Neither strategy increases existing drug use nor leads to drug use initiation. The scientific literature supports assertions that drug abuse issues should be treated primarily as medical and public health rather than criminal justice issues. The effectiveness of both strategies warrants increased support for services, easing of federal and state restrictions governing their availability, and advocacy in their support.

HIV Treatment Outcomes Among HIV-Infected, Opioid-Dependent Patients Receiving Buprenorphine/Naloxone Treatment within HIV Clinical Care Settings: Results From a Multisite Study

“…14 The most effective treatment strategy for the management of opioid dependence remains pharmacotherapies such as prescription of methadone and buprenorphine. 15,16 Methadone maintenance remains highly structured and is limited to licensed treatment settings, limiting access to treatment for providers and patients alike. Currently, methadone treatment is available to only 15% to 20% of opioid-dependent patients in the United States.…”

Iatrogenic opioid dependence is endemic and legal: Genetic addiction risk score (GARS) with electrotherapy a paradigm shift in pain treatment programs

“…with reducing the risk of addiction liability [83]. Finally, these modalities may have a beneficial therapeutic impact on the dilemma of endemic of the opioid prescription in the United States and abroad [5][6][7][8][106][107][108][109].…”

Cannabis legalization: progress in harm reduction approaches for substance use and misuse

“…Beginning in 1989, "drug courts" increasingly allowed individuals arrested for drug-related crimes to be diverted to treatment rather than incarceration (20). Harm-reduction techniques (policies, programs and practices to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws (21)), such as opioid agonist therapy (methadone, buprenorphine (22,23)), needle exchange for the prevention of HIV and hepatitis C transmission (24), and naloxone distribution for the treatment of opioid overdose (25) became increasingly utilized over the ensuing decades. Harm reduction approaches to illicit substance use is perhaps best personified in the U.S. by the LEAD (Law Enforcement Assisted Diversion) program, a public safety program which allows police officers discretionary authority to divert individuals suspected of low level, nonviolent crime to community-based health services instead of arrest, jail and prosecution (26).…”