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."