Why put a time limit on life-saving drug treatment for heroin addicts?

Published on Monday 26 May 2008 21:16

The only call for a "quick fix" in your report, "Call to cut the methadone quick fix" (26 May), comes from Professor Neil McKeganey, who would set a time limit on how long patients may be permitted to receive a medication that for many has been, literally, a life-saver.

Whoever heard of a time limit on any medication, for any illness? Imagine telling diabetics to get their act together – stick to a diet, exercise, etc – but whatever happens, they'll be cut off from insulin after two years. Or refusing to continue cholesterol-lowering medication after a specified period on the assumption that patients must be expected to learn and follow optimal dietary guidelines. Or telling alcoholics – even those who have responded extremely well and managed to maintain sobriety – that two years of Antabuse (or AA meetings) is all they'll get.

Addiction is a chronic medical condition. This was the gist of the Rolleston Committee report 82 years ago, and has been reaffirmed repeatedly ever since, including by such authoritative bodies as the World Health Organisation. Surely Prof McKeganey could not be so blinded by wishful thinking that he fails to realise his proposal would result in virtually all of the "terminated" patients returning to the streets, to heroin, to crime, to getting – and spreading – HIV and other potentially lethal illnesses. One can only pray that the ministers will show more compassion, common sense and understanding than the professor. At stake are the lives of countless individuals and the wellbeing of the entire community.

(DR) ROBERT NEWMAN, MD

West 57th Street

New York City, New York

Professor Neil McKeganey recently recommended the introduction of an arbitrary limit on the duration of methadone treatment. In 2004, the World Health Organisation, Unaids and the United Nations Office on Drugs and Crime released a joint statement endorsing methadone and buprenorphine treatment. In the same year, the WHO added methadone and buprenorphine treatment to its essential drugs list.

Methadone treatment is one of the most frequently evaluated treatments in medicine. It has been found to reduce substantially drug overdose deaths, HIV infection, crime and heroin use while also improving social functioning. If Prof McKeganey's advice is accepted, Scotland can look forward to soaring drug overdose deaths, HIV infection, crime and heroin use while the social functioning of injecting drug users will deteriorate.

The UK already has one of the highest rates of drug overdose deaths in Europe, with higher rates in Scotland than England.

Methadone and buprenorphine treatment should be treated like any other medical treatment. That is, policy and practice should be based on evidence, not on whim. There is no evidence to support Prof McKeganey's advice. If his advice is followed, then some additional drug users may only become drug-free because they have died. This is not what medicine should be for.

(DR) ALEX WODAK

Director, Alcohol and Drug Service St Vincent's Hospital

Darlinghurst, Australia