EARLY RISK OF DEATH IN HEROIN SUBSTITUTE TREATMENT

Those heroin addicts who undergo methadone treatment are almost seven times
more likely to die during the first two weeks on it than those who do not
take methadone, a study in the Medical Journal of Australia has found.

The study examined 67 methadone-related deaths in NSW in 1994 and found 13
people had died in the first two weeks of the treatment. Another 29 who were
not undergoing treatment died after taking methadone prescribed to others as
takeaway doses.

The authors urged the NSW Department of Health to improve the supervision of
addicts in their first two weeks on methadone and to limit their ability to
take the drug away from treatment centres.

One of the authors, Dr John Caplehorn of the University of Sydney, said
treatment was poorly delivered and the program poorly administered.

"Basically, the program is out of control," he said.

The first two weeks of methadone treatment were the danger period because it
was difficult to determine a safe and effective starting dose, the article
said. Patients' reports about their drug use were an unreliable measure of
tolerance for methadone.

"We recommend prescribers be made aware of the risks, signs and symptoms of
methadone toxicity and be required to examine newly admitted patients every
day for the first one to two weeks of maintenance," the study said.

It also called on the Department of Health to ensure compliance with its
policy limiting the takeaway doses available to patients, to reduce deaths
from methadone diverted from the program. But the department's chief health
officer, Dr Andrew Wilson, said it had already taken action to improve the
quality of its program in response to the research.

The department would soon issue new guidelines for prescribing methadone and
assessing patients at the beginning of treatment and had reduced takeaway
doses.

The study found the NSW methadone programs saved the lives of about 68
people in 1994. After two weeks on methadone, death rates of those
undergoing treatment fell to 1/12th of those of the addicts not having the
treatment.

More than 4,000 addicts joined methadone programs in 1994. The study found
25 died after they had been receiving methadone for more than two weeks but
only six of those died from a drug overdose.