THE CURSE OF METHADONE - MEDICAL FACTS

METHADONE was invented in 1941 by chemists at I.G. Farben, the German
chemical giant (Nigel Hawkes writes). Supplies of opium, the basis for
the manufacture of morphine, had been cut off and they were looking
for an alternative painkiller that could be made in the laboratory.

The new compound was named Dolophine. Many sources claim that it was
named after Adolf Hitler, but in fact the name is from the Latin dolor
- - pain. Despite the shortage of morphine, methadone was not used as a
painkiller during the war, but emerged later.

Its chemical structure is rather different from that of the other
opioids, such as heroin and morphine, but like them it binds to
natural opiate receptors in the brain. Unlike heroin, however, it does
so without producing euphoria. It can also be taken orally, rather
than by injection. It enters the brain more slowly than heroin, and
persists longer. By blocking the receptors, it reduces the craving for
heroin.

It was first used in drug-control programmes in New York in the
mid-1960s. By dispensing with needles, the risk of infection is
reduced and since methadone was made available legally, it broke the
link between heroin addiction and crime. Methadone can also be taken
for long periods without damaging side-effects. Despite these apparent
advantages, methadone programmes have always been controversial. An
addict on a properly controlled programme will be given slowly
increasing doses to increase tolerance. Once the addict is used to the
daily methadone dose, the aim is gradually to reduce it, and wean him
off drugs.

In practice, however, many addicts have stayed on methadone for years,
and complain that coming off it is more unpleasant than giving up
heroin. Many methadone addicts will continue to take other drugs.

The evidence for methadone programmes is mixed, at best. The aim of
weaning patients off drugs is not often achieved, unless they have
been addicts for only a short time. Some clinics prescribe injected
methadone, reintroducing the danger of infection through contaminated
needles. And if methadone gets on to the streets and is taken in high
doses it can be lethal.

Despite the doubts about its effectiveness, methadone therapy has
strong supporters. A report by the US Institute of Medicine said that
it was the most rigorously studied form of drug treatment, and had
yielded the most incontrovertibly positive results. "Consumption of
illicit drugs declines. Crime is reduced, fewer individuals become HIV
positive, and individual functioning is improved," the report concluded.