I Think You'll Find It's a Bit More Complicated Than That by Ben Goldacre
Book: I Think You'll Find It's a Bit More Complicated Than That by Ben Goldacre
Read Free Book Online
Authors: Ben Goldacre
Ads: Link
level of seropositivity was less than 5 per cent. 1
A policy of harm reduction tackles public health issues directly by seeking to reduce the personal and social costs of drug use. Abstinence is not regarded as a realistic short-term goal for most dependent users, and the principal ingredients of most programmes are syringe exchanges, educational and advisory services, and treatment and maintenance services (generally with methadone).
There is a hierarchy of achievable objectives, with non-users urged to abstain, and users advised to reduce doses, and to avoid the most potent drugs and riskier means of ingestion. Those who insist on injecting are offered advice on safer technique, and those who persist in sharing needles are even taught how to clean their equipment.
This policy has been vigorously opposed in some parts of the world, especially the USA, where drug-related mortality is almost twice that of the UK. Despite this, it has become the guiding principle behind UK drugs policy, along with the maintenance prescription of methadone.
Methadone
Methadone is an opioid receptor agonist with a half-life of approximately twenty-four hours, far longer than heroin. Drugs with longer half-lives tend to produce less acute withdrawal effects, a phenomenon which is utilised in the choice of anxiolytic drugs in psychiatric practice. Crucially, in comparison with heroin, methadone has a greatly reduced euphoric effect. The hope for methadone, therefore, is that it can contain the opiate cravings, on a once-daily oral dose, without providing so much of a ‘high’.
The aim of methadone maintenance is to stabilise and then to ‘cure’ the opiate user. This breaks down into such objectives as: improving the health of drug users, by providing clean drugs in measured doses under medical supervision; reducing drug-related crime by providing users with free legal opiates, thus reducing their need to steal to fund illicit heroin; improving the social situation of drug users (family relationships, finances, employment, housing and so on); persuading users to reduce their daily dose and ultimately take steps towards abstinence. This is in many ways an updated version of Rolleston’s rationale from 1926.
However, the policy of prescribing methadone may be criticised from many different angles, and to the best of my knowledge these criticisms have never been comprehensively considered in one article. Certainly there is no convenient meta-analysis of methadone programmes. I shall consider each criticism in detail, and later compare the use of methadone to the maintenance prescription of heroin, which still continues on a small scale in the UK, and has recently been reassessed in Switzerland and Australia.
Firstly, it is important to recognise that methadone is not a pleasant drug to take, causing nausea and vomiting, weight gain, profuse sweating, dysphoria and tooth decay. This is no major selling-point to a patient group clearly accustomed to making stringent aesthetic judgements about their drugs, and this, combined with the absence of the ‘buzz’ of heroin, means that the take-up rate amongst addicts is far lower than it ever was for heroin.
Hartnoll et al. (1980) found that only 29 per cent of those offered methadone in one DDU between 1972 and 1975 were still attending twelve months later. The reality of take-up rates for methadone prescription programmes amongst the general population of heroin addicts today is that only a small minority of addicts will attend methadone clinics, certainly less than 15 per cent, although specific statistics are hampered by the unknown quantity of the denominator, that is, the number of people in a population addicted to illicit drugs.
Treatment for drug dependency, to be successful and especially to have an impact at a community level, must have high take-up and retention rates amongst problem drug users who, unlike adults with right iliac fossa pain, may not spontaneously present themselves
A policy of harm reduction tackles public health issues directly by seeking to reduce the personal and social costs of drug use. Abstinence is not regarded as a realistic short-term goal for most dependent users, and the principal ingredients of most programmes are syringe exchanges, educational and advisory services, and treatment and maintenance services (generally with methadone).
There is a hierarchy of achievable objectives, with non-users urged to abstain, and users advised to reduce doses, and to avoid the most potent drugs and riskier means of ingestion. Those who insist on injecting are offered advice on safer technique, and those who persist in sharing needles are even taught how to clean their equipment.
This policy has been vigorously opposed in some parts of the world, especially the USA, where drug-related mortality is almost twice that of the UK. Despite this, it has become the guiding principle behind UK drugs policy, along with the maintenance prescription of methadone.
Methadone
Methadone is an opioid receptor agonist with a half-life of approximately twenty-four hours, far longer than heroin. Drugs with longer half-lives tend to produce less acute withdrawal effects, a phenomenon which is utilised in the choice of anxiolytic drugs in psychiatric practice. Crucially, in comparison with heroin, methadone has a greatly reduced euphoric effect. The hope for methadone, therefore, is that it can contain the opiate cravings, on a once-daily oral dose, without providing so much of a ‘high’.
The aim of methadone maintenance is to stabilise and then to ‘cure’ the opiate user. This breaks down into such objectives as: improving the health of drug users, by providing clean drugs in measured doses under medical supervision; reducing drug-related crime by providing users with free legal opiates, thus reducing their need to steal to fund illicit heroin; improving the social situation of drug users (family relationships, finances, employment, housing and so on); persuading users to reduce their daily dose and ultimately take steps towards abstinence. This is in many ways an updated version of Rolleston’s rationale from 1926.
However, the policy of prescribing methadone may be criticised from many different angles, and to the best of my knowledge these criticisms have never been comprehensively considered in one article. Certainly there is no convenient meta-analysis of methadone programmes. I shall consider each criticism in detail, and later compare the use of methadone to the maintenance prescription of heroin, which still continues on a small scale in the UK, and has recently been reassessed in Switzerland and Australia.
Firstly, it is important to recognise that methadone is not a pleasant drug to take, causing nausea and vomiting, weight gain, profuse sweating, dysphoria and tooth decay. This is no major selling-point to a patient group clearly accustomed to making stringent aesthetic judgements about their drugs, and this, combined with the absence of the ‘buzz’ of heroin, means that the take-up rate amongst addicts is far lower than it ever was for heroin.
Hartnoll et al. (1980) found that only 29 per cent of those offered methadone in one DDU between 1972 and 1975 were still attending twelve months later. The reality of take-up rates for methadone prescription programmes amongst the general population of heroin addicts today is that only a small minority of addicts will attend methadone clinics, certainly less than 15 per cent, although specific statistics are hampered by the unknown quantity of the denominator, that is, the number of people in a population addicted to illicit drugs.
Treatment for drug dependency, to be successful and especially to have an impact at a community level, must have high take-up and retention rates amongst problem drug users who, unlike adults with right iliac fossa pain, may not spontaneously present themselves
Similar Books
