Pubdate: Thu, 07 Dec 2006 Source: Georgia Straight, The (CN BC) Copyright: 2006 The Georgia Straight Contact: http://www.straight.com/ Details: http://www.mapinc.org/media/1084 Author: Gail Johnson Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) Bookmark: http://www.mapinc.org/coke.htm (Cocaine) Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine) EXPERTS DIVIDED OVER USE OF METHADONE New research out of Scotland has concluded that using methadone to treat heroin addiction is a failure. However, many health experts--including some from Vancouver--are critical of the results. Neil McKeganey, professor of drug-misuse research at the University of Glasgow, is considered an authority on illicit substances in his country. His study, which is to be published later this month, determined that giving methadone to heroin addicts has a 97-percent failure rate. He interviewed 695 drug users at the start of treatment in 2001, then again 33 months later to find out whether they had been able to get off drugs. McKeganey found that nearly three years after treatment, only three percent of addicts were drug-free. But some health professionals question the study's design. "That finding doesn't surprise me at all," says Dr. Steve Adilman, clinic coordinator at Vancouver Native Health, which is located in the Downtown Eastside and has approximately 100 clients on methadone at any given time. "Methadone is a highly effective harm-reduction strategy; that's always been how it's been used in North America," Adilman says. "Sure, there are individuals in places who do an abstinence-based model, but if we're talking about the Downtown Eastside, then I would say we'd probably get the same results here. But no one working in the field would say it's a failure." Adilman notes that if McKeganey's study hypothesized that methadone alone would rid addicts of their dependency on all illicit substances, it's no wonder the failure rate was so high. "There is high use of crack cocaine, cocaine, and crystal meth in this city; methadone in no way addresses that," he says. "It takes away someone's craving for opiates and their withdrawal symptoms. I would say more than 80 percent, if not more than 90 percent, of addicts will stop taking opiates when they're adequately dosed with methadone." McKeganey's study also found that 29 percent of addicts who were in residential rehabilitation or who quit heroin cold turkey were clean three years later. In a 2004 article on methadone--a long-acting synthetic opiatelike medication--the BBC News Service described McKeganey as a "noted opponent of the use of methadone to combat addiction". The BBC also reported that a study in England showed strikingly different results: 25 percent of addicts being off illicit drugs within two years of taking methadone. The College of Physicians and Surgeons of British Columbia administers the province's methadone-maintenance program--which currently has 8,121 people enrolled--and issues guidelines for practice to the 356 doctors who are licensed to prescribe the substance for opioid dependency. Dr. Heidi Oetter, the college's deputy registrar, describes methadone as a proven treatment for heroin addiction when used in conjunction with other strategies. "We know treating heroin addiction is so much more than giving people methadone," Oetter says. "There's also counselling, education, nonchemical coping skills... We make it quite clear to physicians that methadone is not a first choice," she adds, noting that the initial approach should be to get addicts off heroin through an abstinence-based program. "The continuation of methadone must be based on the patient benefiting on methadone. If we're not seeing benefits, then we discontinue methadone use." Those benefits include improved mental and physical health, getting off the street, reduced criminal activity, the development of healthy relationships, finding employment, and stopping the use of other mood-altering drugs. Oetter points to two local studies that back up claims of methadone's effectiveness. A report headed by the B.C. Centre for Excellence in HIV/AIDS published earlier this year in Substance Use & Misuse found that methadone protects against binge drug use. Another study, published in Drug and Alcohol Dependence this past February and headed by St. Paul's Hospital's Centre for Health Evaluation and Outcome Sciences, found that enrollment in methadone-maintenance programs by injection-drug users with HIV and hepatitis C resulted in decreased heroin use and better adherence to highly active antiretroviral therapy. Douglas Coleman, a local doctor who specializes in treating addiction, says that McKeganey's study is an example of how methadone is a politically charged subject. "Outcomes [of studies] tend to be influenced by the agenda of those conducting them," he says. Coleman claims that although methadone can be effective in treating opiate dependency, it comes with its own set of problems. "One of the more obvious and easily implemented harm-reduction approaches is methadone maintenance," Coleman says. "I use methadone, but I use it sparingly and when it's part of a comprehensive recovery program. Plus, you have to be prepared to get them [addicts] off methadone, which is harder than getting off heroin. It produces a physical dependence and a painful and prolonged withdrawal. "The problem is that in the harm-reduction approach, there is a sense that addicts cannot achieve a state of abstinence and cannot hold it there....There is a role for methadone, but its use should be much better defined. It's a good transition drug, to get people off the streets so they can take the next step, make plans after they're stabilized on methadone. "Its [methadone's] use at times bespeaks an attitude of resignation, that we can't treat these individuals," he adds. "I find that very sad." - --- MAP posted-by: Richard Lake