Education And Debate

Fortnightly Review: Methadone maintenance treatment in opiate dependence: a review

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6960.997 (Published 15 October 1994) Cite this as: BMJ 1994;309:997
  1. M Farrell,
  2. J Ward,
  3. R Mattick,
  4. W Hall,
  5. G V Stimson,
  6. D des Jarlais,
  7. M Gossop,
  8. J Strang
  1. National Addiction Centre, Institute of Psychiatry and Maudsley Hospital, London SE5 8AF National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2033 Centre for Research on Drugs and Health Behaviour, London SW7 1RQ Beth Israel Medical Centre, New York, NY 10003, USA
  1. Correspondence to: Dr Farrell.

    This paper examines the changes and advances in research and clinical practice and examines the role of treatment structure and programme characteristics in the delivery of methadone maintenance. Methadone prescribing has become much more available over the past decade, both in countries with a history of its use, such as the United Kingdom and Australia, and in countries around the world which previously had not endorsed substitute prescribing.1 There is a need to examine closely the framework in which this treatment is delivered to ensure that the modes of delivery most effective from both cost and benefit perspectives are utilised. This review focuses entirely on methadone maintenance because this is the most extensively evaluated and most used treatment, with about a quarter of a million drug misusers receiving methadone treatment globally. A small number of experimental diamorphine and buprenorphine substitute programmes are being evaluated in several countries.

    Most studies have come from the United States and focus on the long term use of methadone in a specific setting; in contrast, methadone treatment in the United Kingdom has received virtually no formal evaluation to date bar one study.2 There is concern that a considerable amount of the methadone prescribing could be having little impact on illicit drug use or risk taking behaviour,3 a recent study of drug users in police custody echoes this.4 The Advisory Council on the Misuse of Drugs has recommended a shift to a more structured approach for delivery of oral methadone maintenance.

    The organisation and regulation of methadone maintenance treatment varies widely, with explicit guidelines for programme operation in the United States and Australia and a virtual absence of structure and regulation in Britain. It is likely that policy analysts and treatment providers in countries with high levels of regulation and structured programmes …

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