THE SCOURGE OF HEROIN

Sir, - As a family doctor who has been deeply involved in caring for
patients addicted to heroin and for their families in Dublin over the past
10 years, I have always welcomed your newspaper's enlightened approach to
the problem of drug addiction. This approach is in general to address the
fundamental causes of drug addiction and to explore appropriate management
strategies. Breda O' Brien's article entitled "Moving beyond maintainence [sic]
in drug addiction" (Opinion, June 24th) was one such excellent article,
which once again drew our attention to the root causes of drug addiction in
Irish society.

While I am reluctant to criticise this article, which advocates strongly on
behalf of people caught in the trap of heroin addiction, as a doctor
involved in the treatment of many such patients I must take issue with two
assumptions made. The first is that "methadone means that a person copes
with life by being partially stoned all the time."

Methadone is the most widely researched drug used in the management of
heroin addiction, and the published evidence is that when methadone is
taken in therapeutic dosage on a long term basis, it does not impair
intellectual function nor does it alter mood. In these circumstances the
only side-effects are constipation and increased sweating.

While methadone has been shown to be highly effective in enabling patients
to abstain from heroin, it has not been shown to be effective in enabling
patients to abstain from benzodiazepines or alcohol, and it is the misuse
of these drugs which may cause some patients to appear to be "stoned".

The second (implied) assumption is that heroin addiction is largely a
psychological one and that if the original psychological precipitating
causes are removed (following a period of "methadone detoxification"), then
cure may result.

Unfortunately the overwhelming scientific evidence does not support this
proposition but rather concludes that once opiate addiction is established,
permanent and irreversible neuro-physiological damage occurs which renders
the patient vulnerable to relapse indefinitely, in a similar fashion to
alcohol addiction.

Fortunately, there is widespread international evidence that methadone can
safely and effectively reduce this vulnerability to relapse. It is
undoubtedly true that the most effective means of preventing heroin
addiction is to redress social injustice in our society. It is also likely
that a more just society would reduce the vulnerability of heroin addicts,
thereby enabling a greater number to safely discontinue their methadone
medication.

Doctors and other workers in this field must in the meantime offer their
patients the safest and most effective form of treatment available, while
at the same time advocating on their behalf and engaging in "the debate
about the nature of the emptiness which afflicts so many people's lives".
- - Yours, etc.,

Kieran Harkin MRCPI, MRCGP,
General Practitioner,
Inchicore Medical Centre;
Medical Officer,
Rialto Community Drug Team