Methadone is key to effective drug treatment

AS a group of experts in the treatment of opiate-dependent people, we write to express our dismay about the continuing misrepresentation in the media of the evidence on the effectiveness of methadone treatment.

The purpose of this treatment for the distressing condition of opiate dependency is perhaps misunderstood. People with serious addictions are at great risk of death from overdose and infection.

This is nowhere more obvious than in Scotland where there has been an outbreak of infections and deaths caused by anthrax and where there were nearly 600 drug-related deaths last year.

Methadone can prevent death, stabilise lifestyles and improve social functioning. It is remarkable to those of us who provide this life-saving treatment what improvement is seen when people start this therapy. Treatment has to be supported by a programme of psychological and social support, at least for the first few months, and has to be continuous. Some people will need long-term and even lifelong treatment.

Compared to other essential medical therapies, methadone is not expensive. Most patients who benefit from methadone treatment can live otherwise normal lives.

The media repeatedly report a view of methadone treatment that is simply contrary to the extensively documented worldwide clinical and research experience of many decades.

Reliable and persistent research shows that methadone treatment substantially reduces deaths, crime, HIV infection and drug use while also assisting social functioning such as improved education, training, parenting and employment. Every 1 spent on methadone treatment saves between 4 and 7. Methadone treatment has been endorsed by three UN agencies: the United Nations Office on Drugs and Crime; the World Health Organisation and UNAIDS.

WHO has also included methadone treatment in its "essential medicines" list and 70 countries in the world now provide methadone or buprenorphine treatment to an estimated one million patients.

No treatment in medicine works every time with every patient, but methadone treatment has helped more people in the world overcome their problems with heroin than any other. This treatment should be readily available to every person using heroin that seeks help, accepts this option and meets national criteria.

If policymakers were to heed the critics' advice to close down methadone treatment, or impose an arbitrary time limit on its administration, the community can anticipate more overdose deaths, more HIV and more crime. Surely this is not what the public want and deserve.

It is essential that policy and treatment services are clear about the value and importance of methadone treatment.

Dr. Roy Robertson FRCP(Ed) FRCGP,

General Practitioner and Reader

University of Edinburgh,

Scotland

[email protected]

Professor Sheila M. Bird

MRC Biostatistics Unit

Robinson Way

CAMBRIDGE CB2 0SR

Dr Malcolm Bruce MB,ChB, FRCPsych, PhD

Consultant Psychiatrist in Addiction

Community Drug Problem Service

22-24 Spittal Street

Edinburgh

Scotland

Dr John Budd

GP with special interest in substance misuse.

Edinburgh Access Practice

Professor M.Patrizia Carrieri, PhD

Epidemiologist

National Institute for Health and Medical Research

UMR 912

Marseilles

Dr. Timothy Christie, BA(hons), MA, MHSc, PhD

Regional Director, Ethics Services, Horizon Health Network

Adjunct Professor, Department of Bioethics, Dalhousie University

Lecturer, Department of Languages and Humanities, University of New Brunswick

Saint John Regional Hospital

Saint John, New Brunswick

Dr Lucinda Cockayne

Lead Clinician, NHS Fife Addiction Services

Consultant Psychiatrist

Honorary Senior Lecturer St Andrews University

Ward 11, Cameron Hospital

Windygates

Fife

KY8 5RR

Andrej Kastelic

CENTER FOR TREATMENT OF DRUG ADDICTION SLOVENIA

University Psychiatric Hospital

Zaloska 29, 1000 Ljubljana, SLOVENIA

Nuno Portugal Neto Capaz

Sociologist, Vice President of the Comisso para a Dissuaso da Toxicodependncia de Lisboa

Lisboa, Portugal

Univ.Prof. Dr. Gabriele Fischer

Medizinische Universitt Wien

Universittsklinik fr Psychiatrie und Psychotherapie

Whringergrtel 18-20

1090 Wien, Austria

Douglas Gourlay MD, MSc, FRCPC, FASAM

Medical Consultant,

Centre for Addiction and Mental Health,

Toronto, Ontario CANADA

Dr Shay Griffin

Consultant in Addiction Psychiatry

Monklands Hospital

Airdrie

Lanarkshire ML6 0JS

Marc Reisinger, Psychiatrist

European Opiate Addiction Treatment Association

Brussels,

Belgium

Professor Adeeba Kamarulzaman

FRACP

Professor of Medicine and Infectious Diseases

University of Malaya

Kuala Lumpur.

Malaysia

Shui Shan Lee, MD, FRCP, FRCPA, FFPH

Professor of Infectious Disease

The Chinese University of Hong Kong

205 Postgraduate Education Centre

Prince of Wales Hospital, Shatin

Hong Kong

Dr. Garrett McGovern

GP Specialising in Substance Abuse,

HSE Addiction Services,

Baggot Street Clinic,

19 Haddington Road,

Dublin 4, Eire

Dr John Macleod

Reader in Clinical Epidemiology and Primary Care

Department of Social Medicine

University of Bristol

Canynge Hall

39 Whatley Road

Bristol

BS8 2PS

Thomas Kerr, PhD

Director, Urban Health Research Initiative

British Columbia Centre for Excellence in HIV/AIDS

Assistant Professor, Dept. of Medicine

University of British Columbia

Michael Smith Foundation for Health Research Scholar

St. Paul's Hospital

608-1081 Burrard Street

Vancouver, British Columbia

Canada, V6Z 1Y6

Bill Nelles

Addiction Counsellor

Beach Rd Medical Centre

Qualicum Beach BC

Canada

Dr. Robert Newman, MD, MPH, Director Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center

555 W. 57th St.

NY NY 10019, USA

Kasia Malinowska-Sempruch

Director, Global Drug Policy Program, OSI

Dr. Marta Torrens

Director of Addiction Department

Institute of Psychiatry and Addiction

Parc de Salut Mar

Universitat Autnoma de Barcelona

Barcelona

Spain

Prof. Ernest Drucker PhD

Professor Emeritus of Family and Social Medicine

Montefiore Medical Center/

Albert Einstein College of Medicine

and

Adjunct Professor of Epidemiology

Columbia University

Mailman School of Public Health, USA

Matt Hickman

Reader in Public Health and Epidemiology

Department of Social Medicine

University of Bristol

Canynge Hall

39 Whatley Road

Bristol, UK

Dr Jane Jay,

Consultant Physician,

Past Chair,

National Forum Drug Related Deaths,

Scotland

Herman Joseph, Ph.D., Consultant,

NYC Harm Reduction Coalition, National Alliance of Methadone Advocates Recovery (NAMAR) and National Development Research Institute, Inc. (NDRI), USA

Kasia Malinowska-Sempruch

Director, Global Drug Policy Program Open Society Institute,

Warsaw,

Poland

Mark W. Parrino, M.P.A.

President

American Association for the Treatment of Opioid Dependence (AATOD)

225 Varick Street, Suite 402

New York, NY 10014

Hans-Guenter Meyer-Thompson

Professor John Strang

Addictions Department

National Addiction Centre

Addiction Sciences Building

4 Windsor Walk

Denmark Hill

London, UK

Dr Chris Ford

Clinical Director SMMGP & GP Principal

Lonsdale Medical Centre

24 Lonsdale Road

London, UK

Prof. Wayne Hall,

NHMRC Australia

Fellow UQ Centre for Clinical Research and School of Population Health,

The University of Queensland,

Herston Qld 4029,

Australia

Dr Kennedy Roberts OBE,

Medical Practitioner,

Edinburgh Drug Addiction Study

Muirhouse Medical Group,

Edinburgh, Scotland

Marc Shinderman, MD

Psychiatry/Addiction Medicine

Chicago IL

US

Ian Stolerman

Emeritus Professor of Behavioural Pharmacology

Institute of Psychiatry P048

King's College London

De Crespigny Park

London SE5 8AF, UK

Em. Prof. Ambros Uchtenhagen, MD, PhD

President, Research Foundation for Public Health and Addiction, affiliated with Zurich University, Switzerland

Dr. Albrecht Ulmer,

Specialist in HIV and Addiction Medicine

Cofounder of the German Society for Addiction Medicine Stuttgart,

Germany

Dr Richard Watson

Clinical Lead Substance Misuse

Royal College of General Practitioners (Scotland)

Prof. dr. Wim van den Brink, MD PhD

Amsterdam Institute for Addiction Research (AIAR)

Academic Psychiatric Centre AMC-UvA

room nr PA 1.188

PO box 22660

1100 DD Amsterdam

The Netherlands

Dr. Alex Wodak FRACP, FAChAM, FAFPHM, MB BS,

Director, Alcohol and Drug Service,

St. Vincent's Hospital,

Darlinghurst, NSW, 2010,

Australia

Kerry Wolf,

Board of Directors,

National Alliance for Medication Assisted Recovery,

Austin, Texas

USA

Evan Wood, M.D., Ph.D.

BC Centre for Excellence in HIV/AIDS &

Associate Professor, Division of AIDS

Department of Medicine, UBC

Stephan Walcher, MD,

Anesthesiologist, Internist, GP, Pain and Addiction Specialist

CONCEPT, Outpatient Addiction Clinics in Munich

Germany