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Heroin addicts benefit from better access to methadone

by Reuters Health, 3/8/200. Originally posted circa 2000; revised 10/15/2004: [ .htm].

The articles referred to in this document are available. Please see: "Treatment for Opiate Dependence" by Rounsaville & Kosten, and, "Methadone Maintenance vs 180-day Psychosocially Enhanced Detoxification for Treatment of Opioid Dependence" by Sees, et al.  Both are from JAMA 283(10); 2000.

NEW YORK, Mar 08 (Reuters Health) -- More heroin addicts in the US could get treatment if doctors were allowed to dispense methadone in their office, according to results of a study on such a program in two cities in Scotland.

Currently, heroin addicts in the US must report daily to special clinics that dispense methadone, a liquid narcotic that is used to wean addicts away from heroin. Such programs reach only about 14% of addicts because of location and limited treatment slots.

According to the report in the March 8th issue of The Journal of the American Medical Association, a program in which local doctors prescribed methadone has been successful in two cities in Scotland, and similar programs should be tried in the US.

"The implementation of methadone prescription expanded access for people with opioid abuse, and certainly in the Edinburgh experience, dramatically dropped the rate of new HIV cases,'' Dr. Michael Weinrich, from the University of Maryland in Baltimore, told Reuters Health. In Glasgow, the program has been credited with reducing property crimes and reducing the number of methadone-related deaths.

Noting that physicians were largely responsible for providing leadership for the programs in Scotland, Weinrich said that "physicians need to be advocates in their communities for this type of treatment.'' The US Department of Health and Human Services is considering a change in the current drug abuse treatment policy, and may allow doctors outside methadone clinics to dispense the drug. However, some are concerned that such a program might overwhelm family physicians or increase methadone availability on the illegal drug market.

In the study, Weinrich and colleague Dr. Mary Stuart, looked at the success of two such programs in Edinburgh and Glasgow. In Edinburgh, the program was started in response to a high prevalence of HIV.

Doctors in those communities were allowed to dispense methadone if they agreed to follow certain guidelines, including -- at least in Glasgow -- observing addicts as they take their methadone for at least the first year. Although doctors in both cities are given only a nominal reimbursement for participating, 59% of primary care physicians in Edinburgh, and 30% of primary care physicians and 75% of community pharmacies in Glasgow participated in the program.

Overall, 60% to 80% of injection drugs users in Edinburgh and 41% to 73% in Glasgow were enrolled in methadone maintenance in 1998-1999, a 3- to 5-fold increase in treatment rates. During the study, 17 methadone-related deaths occurred in Glasgow and 30 deaths occurred in Edinburgh, suggesting that supervised consumption of methadone reduces the risks of methadone-related death.

In an accompanying editorial, Dr. Bruce J. Rounsaville of the Veterans Affairs Healthcare Systems in West Haven, Connecticut, and Dr. Thomas R. Kosten of the Yale University School of Medicine in New Haven, Connecticut, urge that ''implementation of primary care opioid treatment should not be delayed until definitive answers are available.'' They also suggest that the Scottish model might apply to the use of drugs for the treatment of alcoholism and other substance abuse disorders.


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Alexander DeLuca, M.D.

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Originally posted:  10/5/2004

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Heroin addicts benefit from better access to methadone

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