Pubdate: 13 March 1999 Source: Sunday Times (UK) Contact: http://www.sunday-times.co.uk/ Copyright: 1999 Times Newspapers Ltd. THE CURSE OF METHADONE - MEDICAL FACTS METHADONE was invented in 1941 by chemists at I.G. Farben, the German chemical giant (Nigel Hawkes writes). Supplies of opium, the basis for the manufacture of morphine, had been cut off and they were looking for an alternative painkiller that could be made in the laboratory. The new compound was named Dolophine. Many sources claim that it was named after Adolf Hitler, but in fact the name is from the Latin dolor - - pain. Despite the shortage of morphine, methadone was not used as a painkiller during the war, but emerged later. Its chemical structure is rather different from that of the other opioids, such as heroin and morphine, but like them it binds to natural opiate receptors in the brain. Unlike heroin, however, it does so without producing euphoria. It can also be taken orally, rather than by injection. It enters the brain more slowly than heroin, and persists longer. By blocking the receptors, it reduces the craving for heroin. It was first used in drug-control programmes in New York in the mid-1960s. By dispensing with needles, the risk of infection is reduced and since methadone was made available legally, it broke the link between heroin addiction and crime. Methadone can also be taken for long periods without damaging side-effects. Despite these apparent advantages, methadone programmes have always been controversial. An addict on a properly controlled programme will be given slowly increasing doses to increase tolerance. Once the addict is used to the daily methadone dose, the aim is gradually to reduce it, and wean him off drugs. In practice, however, many addicts have stayed on methadone for years, and complain that coming off it is more unpleasant than giving up heroin. Many methadone addicts will continue to take other drugs. The evidence for methadone programmes is mixed, at best. The aim of weaning patients off drugs is not often achieved, unless they have been addicts for only a short time. Some clinics prescribe injected methadone, reintroducing the danger of infection through contaminated needles. And if methadone gets on to the streets and is taken in high doses it can be lethal. Despite the doubts about its effectiveness, methadone therapy has strong supporters. A report by the US Institute of Medicine said that it was the most rigorously studied form of drug treatment, and had yielded the most incontrovertibly positive results. "Consumption of illicit drugs declines. Crime is reduced, fewer individuals become HIV positive, and individual functioning is improved," the report concluded. - --- MAP posted-by: Rich O'Grady