METHADONE MAINTENANCE

Sir, - In his response to Breda O'Brien's excellent article on "Moving
beyond maintenance" (Opinion, June 24th), Dr Kieran Harkin (June 29th)
makes a number of surprising claims.

He states that, once opiate addiction is established, permanent and
irreversible neuro-physiological damage occurs, rendering the person
prone to relapse indefinitely. He doesn't add how this damage is
assessed or who reaches this conclusion while, presumably, the
addicted young person is still abusing drugs. We can presume that he
means a doctor, who subscribes to this theory, makes this devastating
diagnosis.

The doctor then prescribes the highly addictive full-strength opiate,
methadone, which over time will inflict brain damage to the point
where the person cannot do without it, and cannot attempt a life free
of drugs. Street heroin is a very dilute substance compared with
methadone. It is certainly clear that an addicted person availing of
health services will not be encouraged to seek detoxification.

Do the doctors in the health service who think as Dr Harkin does
inform the client of their diagnosis? Do they warn the patient that
the drug being prescribed for him can damage his brain? Do they tell
him he is being put on the opiate methadone for life? Clients have a
right to know, as we the citizens have a right to know the basis on
which our drugs service is operating.

Contrary to this medical stance, drug addiction is a psycho-social
problem and unless we get away from the inappropriate medical/public
health model our addiction crisis will continue to get worse,
particularly if this thinking is applied to the rest of the country
which is still not too heavily infested with heroin and methadone.

Currently, there are 5,000 young people on methadone with little
likelihood of them achieving a drug-free healthy state. At the same
time, residential drug free recovery programmes have been starved of
investment. In the Dublin area there are 50 people on methadone for
every one place in drug-free residential recovery.

We should thank Dr Harkin for alerting us to the medical thinking
which, it would appear, is part of Department of Health policy. The
Minister for Health needs to clarify his policy as the consequences
for young people are so shocking - and unacceptable.

Happily not all psychiatrists and doctors share this no-escape view of
addiction and continue to believe in the capability of human beings to
recover. Substituting one addictive opiate for another opiate traps
people in addiction. - Yours, etc.,

Jim Cumberton,
Chairman, Drug Prevention Alliance,
Oaklands Park,
Dublin 4.