PUBLIC HEALTH by Ross ColquhounNews Weekly
Methadone cure worse than the heroin addiction
, July 4, 2015
The introduction of methadone as part of treatment for heroin use was an attempt to reduce the harm associated with heroin addiction.
The major harm to be prevented was HIV infection related to sharing needles to inject the drug. However, there has been no convincing evidence to demonstrate that methadone has had any impact on HIV rates.
Some observational research has shown that methadone tends to reduce heroin use, improve health outcomes, reduce overdose deaths and reduce drug-related crime. But the evidence is weak and reviews of the controlled trials comparing methadone to no treatment indicate that there is no difference in terms of criminality and mortality. No trials have shown any improvement in health outcomes or reduction in HIV transmissions.
Greater danger of overdose
Moreover, people dependent on methadone continue to overdose and die at alarming rates. In Scotland methadone is implicated in 60 per cent of drug-related deaths.
Very few people manage to stop using methadone, with only 3 per cent ceasing use each year despite being “in treatment”. Research shows that those who have no treatment and have never been on methadone achieve abstinence at much higher rates.
Methadone does not have any proven effect other than to retain people in treatment or reduce injecting-drug use in the short term. And yet in Australia thousands are hopelessly addicted to this dangerous drug.
Methadone is also more addictive than heroin and has negative long-term consequences in terms of health and social outcomes. Moreover, many people on methadone continue to use heroin and to develop addictions to other drugs. They also often find it very difficult to find or retain employment, they find it difficult to be emotionally available to their partners or children, and their freedom is compromised. And despite claims to the contrary, retention in these programs is also poor, with fewer than half still in the programs at six months.
As a secondary benefit, methadone was meant to enable heroin addicts to stabilise their lives and then move from addiction to abstinence. These aims have clearly been abandoned, with people now having been on these drugs for 30 years or more and a black market in methadone thriving, meaning that these drugs are often more accessible than heroin.
Most disturbing is the fact that health authorities have no idea how to get people off methadone once its usefulness has expired.
At present in Australia there are around 46,000 people on agonist maintenance programs (mainly methadone), which directly cost the community $150 million each year at an estimated cost of $4500 per person.
While methadone maintenance remains the most researched treatment for the problem of opioid dependence, and despite the widespread use of methadone maintenance treatment for opioid dependence in many countries, it remains a controversial treatment, the effectiveness of which has been disputed for good reasons.
It was also believed that if methadone could reduce injecting behaviour among heroin addicts, then it would by default reduce needle sharing and so prevent HIV infection and improve health outcomes. Yet, for several reasons, this has not been shown to be true.
First injecting-drug use is at best reduced, not stopped. Moreover, as people tend to stay on methadone for many years it is likely that overall injecting behaviour is prolonged. Second, it is recognised that it can be effective only if injecting-drug users stop sharing needles. To prevent needle sharing sterile needles have been provided at a cost of $40 million each year.
The research indicates that many tend to continue to share due to factors such as impulsive behaviour associated with drug use and the social norms among injecting groups, and that provision of clean needles reduces sharing by only 15 per cent.
Besides which, all the research shows that needle sharing is responsible for only 3 to 4 per cent of HIV transmission at most. The vast majority of new cases arise among homosexual men, and is associated with high rates of sexually transmitted diseases.
These facts mean that even if methadone were effective in reducing injecting rates and needle sharing, it would still have negligible or no effect on HIV infection rates.
Clearly, the claims made and the aims espoused have not been realised despite the costs to the community. It requires an urgent review of the role of methadone, based on the evidence.
Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow, and a member of the Drug Advisory Council of Australia.