Methadone comes of age - almost...
April, 2005
Imagine there was a simple, effective and affordable medicine that could
reduce the death rate among people who use drugs such as heroin by about
two-thirds. Fat chance? Now imagine that medicine does exist, but that
because of a reluctance on the part of policy-makers and government
officials, it was not widely avoidable in many countries. Hard to
believe? Dream no more. The medicine exists and is hopefully about to
break out of its shrouded history: methadone is coming of age.
Between 5 and 10% of the world's HIV infections are reportedly due to
injection drug use. The figure may rise to as high as 70% of HIV
transmission in some countries - in Asia and Europe in particular.
Injection drug use is also now the predominant mode of transmission of
hepatitis C virus throughout the world.
Due to the unregulated nature of illicit substances, injection drug
users often use drugs of unknown potency and quality, which can
frequently lead to overdoses. It is estimated that approximately 2-3% of
injection drug users die each year, resulting in a mortality rate for
heroin users, for example, of between six and twenty times that seen
among those in the general population of the same age and sex.
Substitution therapy is a treatment approach that helps opioid drug
users (e.g. Heroin) to reduce the withdrawal symptoms and craving when
drug use is stopped or reduced. Methadone is one of the oral medications
used for substitution therapy. Because users taking methadone are far
less likely to inject drugs, it also has a significant impact on
reducing their risk of HIV injection.
In their recent position paper Substitution maintenance therapy in the
management of opioid dependence and HIV/AIDS prevention, the World
Health Organization (WHO), United Nations Office on Drugs and Crime
(UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS)
state that opioid "drug dependence treatment is an important strategy to
improve well-being and social functioning of people with opioid
dependence and to reduce its health and social consequences, including
HIV infection."
Participation in substitution maintenance therapy also provides
opportunities for early diagnosis of other health problems, HIV,
Tuberculosis, Hepatitis and STD counselling and testing, as well as
referral for additional services. It is arguably the most effective,
cost effective treatment option for injection drug users, and brings
them into contact with various other services within the health system.
The UN paper further enlightens that "methadone maintenance therapy is
correlated with reduction in HIV risk behaviours related to drug-taking,
or an increase in protective behaviours." According to WHO, "IDUs who do
not enter [methadone] treatment are up to six times more likely to
become infected with HIV than injectors who enter and remain in
treatment."
"The death rate for people with opioid dependence in methadone
maintenance treatment is one-third to one-quarter the rate for those not
in treatment."
According to several conservative estimates, every dollar invested in
opioid dependence treatment programmes may yield a return of between $4
and $7 in reduced drug-related crime, criminal justice costs and theft
alone. When savings related to health care are included, total savings
can exceed substitution therapy costs by a ratio of twelve to one.
The UN position paper concludes that because substitution therapy (also
known as pharmacotherapy) has proven effective in terms of promoting
retention of users in treatment, reduction of drug use, improvements of
drug users' psychological and social functioning, as well as reduction
of risk-associated injecting and sexual behaviours, it should be given
serious consideration both as an HIV prevention measure, and as a
treatment measure for individuals with opioid dependence who are already
infected with HIV.
"Programmes that combine pharmacotherapy with HIV/AIDS treatment and
care should be encouraged as directly observed pharmacotherapy also
provides an opportunity for directly observed antiretroviral therapy, as
well as therapy for opportunistic infections such as tuberculosis," the
paper states.
"Individuals with opioid dependence benefit from substitution
maintenance therapy through increased stability and improved well-being
and social functioning. People receiving substitution therapy can make
significant progress in their physical and emotional life, as well as in
their relationships with others and their ability to contribute
meaningfully to their community and society at large."
